Incontinence: The Daily PANCE Blueprint

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Incontinence: The Daily PANCE Blueprint

A 72-year-old female with a history of a stroke presents to the clinic complaining of an increased urge to urinate and involuntary leakage of urine for the past few months. Which of the following best explains what this patient is experiencing?

A. Detrusor overactivity leading to detrusor muscle contractions
B. Detrusor underactivity caused by impaired contractility of detrusor muscle
C. Urethral hypermobility from insufficient support of pelvic floor musculature
D. Hyperglycemia leading to osmotic diuresis
E. None of the above

Answer and topic summary

The answer is A. Detrusor overactivity leading to detrusor muscle contractions

The patient has an overactive bladder (aka urgency urinary incontinence). The cause is detrusor overactivity leading to detrusor muscle contractions. Risk factors include neurological conditions like a stroke, spinal cord injury, Parkinson’s disease, etc. Patients will often complain of having the urge to go, but they can’t make it to the bathroom in time. The first-line management of urge incontinence is a trial of pelvic floor exercise, lifestyle changes (e.g., smoking cessation + weight loss), and bladder training. First-line pharmacologic treatment may include anticholinergic drugs (e.g., oxybutynin) or beta-3 adrenergic agonists (e..g, mirabegron).

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Covered under ⇒ PANCE Blueprint Genitourinary ⇒ Bladder disorders ⇒ Incontinence