Urinary Incontinence: Evaluation and Diagnosis

  • Ananias C. Diokno
  • Michelle J. Lajiness
  • Tomas Lindor Griebling


Urinary incontinence is one of the most common urologic conditions diagnosed in older adults. It is imperative that clinical practitioners have a working knowledge of the different types of urinary incontinence and the factors that can cause this for older patients. This approach is critical in order to correctly diagnose urinary incontinence and to help make therapeutic decisions. It is indeed the starting point of management for all patients with urinary incontinence regardless of the clinical setting, including the outpatient clinic, acute care hospital, rehabilitation unit, or long-term care facility. This chapter presents an overview of the various types of urinary incontinence and methods for clinical evaluation and diagnosis.


Urinary Incontinence Stress Urinary Incontinence Bladder Outlet Obstruction Urge Urinary Incontinence Pelvic Floor Muscle Strength 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Haylen BT, Ridder D, Freeman RM, Swift SE, Berghmans JL, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association, International Continence Society joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2009;29:4–20.Google Scholar
  2. 2.
    Resnick NM, Yalla SV. Geriatric incontinence and voiding dysfunction. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell’s urology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2007. p. 2305–12.Google Scholar
  3. 3.
    Newman D, Wein A. Managing and treating urinary incontinence. Baltimore, MD: Health Professionals Press; 2009. p. 85–122.Google Scholar
  4. 4.
    Diokno AC, Toh KL. Urinary incontinence in the elderly. In: Bourcier AP, McGuire EJ, Abrams P, editors. Pelvic floor disorders. Philadelphia, PA: Elsevier Saunders; 2004. p. 57–72.Google Scholar
  5. 5.
    Burgio KL, Matthews KA, Engel BT. Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. J Urol. 1991;146: 1255–9.PubMedGoogle Scholar
  6. 6.
    Diokno AC, Brock BM, Brown MB, Herzog AR. Prevalence of Urinary Incontinence and other urologic symptoms in the non- institutionalized elderly. J Urol. 1986;136:1022–5.PubMedGoogle Scholar
  7. 7.
    Ham RJ, Sloane PD. Primary care geriatrics: a case base approach. St Louis, MO: Mosby Yearbook; 1992. p. 385–403.Google Scholar
  8. 8.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. For the standardization sub-committee of the International Continence Society (2002) the standardization of terminology of lower urinary tract function: report from the Standardization Sub-Committee of the International Continence Society. Neurourol Urodyn. 2002;21:167–78.PubMedCrossRefGoogle Scholar
  9. 9.
    Herzog AR, Diokno AC, Brown MB, et al. Two-year incidence, remission, and change patterns of urinary incontinence in noninstitutionalized older adults. J Gerontol. 1990;45(2):M67–74.PubMedCrossRefGoogle Scholar
  10. 10.
    Diokno AC, Catipay JR, Steinert BW. Office assessment of patient outcome of pharmacologic therapy for urge incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(5):334–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Diokno AC, Brock BM, Herzog AR, Bromberg J. Medical correlates of urinary incontinence in the elderly. Urology. 1990;36:129–38.PubMedCrossRefGoogle Scholar
  12. 12.
    National Center for Health Statistics. The National Nursing Home Survey: 1977 summary for the United States by Van Nostrand JF, et al. (DHEW Publication No. 79–1794). Vital and health statistics. Series 13, No. 43. Washington DC: Health Resources Services Administration, US Government Printing Office; 1979.Google Scholar
  13. 13.
    Palmer MH, German PS, Ouslander JG. Risk factors for urinary incontinence one year after nursing home admission. Res Nurs Health. 1991;14:405–12.PubMedCrossRefGoogle Scholar
  14. 14.
    Palmer MH, McCormick KA, Langford A, Langlois J, Alvaran M. Continence outcomes: documentation on medical records in the nursing home environment. J Nurs Care Qual. 1992;6(3):36–43.PubMedCrossRefGoogle Scholar
  15. 15.
    Campbell AJ, Reinken J, McCosh L. Incontinence in the elderly: prevalence and prognosis. Age Ageing. 1985;14:65.PubMedCrossRefGoogle Scholar
  16. 16.
    Ouslander J, Kane R, Abrass I. Urinary incontinence in elderly nursing home patients. JAMA. 1982;248: 1194–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5(1/2):165–73.Google Scholar
  18. 18.
    Fultz NH, Jenkins KR, Ostbye O, Taylor DH, Kabeto MU, Langa KM. The Impact of own and spouse’s urinary incontinence on depressive symptoms. Soc Sci Med. 2005;60:2537–48.PubMedCrossRefGoogle Scholar
  19. 19.
    Sung VW, West DS, Hernandez AI, Wheeler TI, Myers DI, Subak LI. Association between urinary incontinence and depressive symptoms in overweight and obese women. Am J Obstet Gynecol. 2009; 200(5):557 e1–7 e5.Google Scholar
  20. 20.
    Girman CJ, Jacobsen SJ, Guess HA, Oesterling JE, Chute CG, Panser LA, Lieber MM. Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate. J Urol. 1995;153(5):1510–5.PubMedGoogle Scholar
  21. 21.
    Brink CA, Wells TJ, Sampselle CM, et al. A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res. 1994;43(6):352–6.PubMedGoogle Scholar
  22. 22.
    Diokno AC, Bourodulin G. A new vaginal speculum for pelvic organ prolapse quantification (POPQ). Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(5): 384–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Miller JM, Ashton-Miller JA, Delancey JO. Quantification of cough- related urine loss using the paper towel test. Obstet Gynecol. 1998;91(5 pt 1): 705–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Lose G, Jorgensen L, Thunedborg P. 24 hour home pad weighing test versus 1 hour ward test in the assessment of mild stress incontinence. Acta Obstet Gynecol Scand. 1989;68(3):211–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Victor A, Larsson G, Asbrin AS. A simple patient-administered test for objective quantitation of the symptom of urinary incontinence. Scand J Urol Nephrol. 1987;21(4):277–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Winters JC, Dmochowski RR, Goldman HB, Herndon CDA, Kobashi KC, Kraus SR, Lemack GE, Nitti VW, Rovner ES, Wein AJ, American Urological Association (AUA) Guideline. Adult urodynamics: AUA/SUFU guideline. 2012. Linthicum, MD, American Urological Association.
  27. 27.
    Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, Das AK, Foster Jr HE, Scarpero HM, Tessler CD, Vasavada SP, American Urological Association (AUA) Guideline. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455–63.PubMedCrossRefGoogle Scholar
  28. 28.
    Glazener CMA, Lapitan MCM. Urodynamic studies for management of urinary incontinence in children and adults (review). Cochrane Database Syst Rev. 2012;1:CD003195.Google Scholar
  29. 29.
    Bromage SJ, Dorkin TJ, Chan L, Tse V. Urodynamics in the octogenarian female: is it worthwhile? Int Urogynecol J. 2010;21:1117–21.PubMedCrossRefGoogle Scholar
  30. 30.
    Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ, Messing EM, Miller SD, Peterson AC, Turk TMT, Weitzel W, American Urology Association (AUA) Guideline. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012;188(6 Suppl): 2473–81.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ananias C. Diokno
    • 1
  • Michelle J. Lajiness
    • 1
  • Tomas Lindor Griebling
    • 2
  1. 1.Beaumont Medical Office BuildingRoyal OakUSA
  2. 2.Department of Urology and The Landon Center on AgingUniversity of Kansas School of MedicineKansas CityUSA

Personalised recommendations