Overactive bladder (detrusor instability)
Outflow obstruction e.g. prostatism
Serious disorders not to be missed
Neurogenic: multiple sclerosis, neuropathy, others
Interstitial cystitis (women)
Post pelvic fracture
Drugs (see list in history)
Endocrine: diabetes insipidus
Spinal dysfunction incl. cauda equina lesion
Is the patient trying to tell me something?
Focus on the duration and patterns of voiding, bowel function, drug use, obstetric and pelvic surgery history. A voiding diary is helpful to pinpoint the cause. Use of a severity index questionnaire is very helpful. Obstructive symptoms in men with detrusor overactivity. Consider a sleep related problem. Check drug history: diuretics, alcohol, sedatives, antidepressants, α-adrenergic blockers e.g. prazosin, caffeine, psychoactive agents, anticholinergics, calcium channel blockers e.g. nifedipine.
Based on neurological, pelvic and rectal examinations
Consider (based on specialist referral):
Classify incontinence into the main categories: stress, urge and continuous (overflow).