The Women's Preventive Services Initiative recommends annually screening for women of all ages, including adolescents, for UI despite low-quality evidence for accuracy of screening methods and insufficient evidence regarding the effectiveness of screening in improving symptoms, QOL, and function. ![]() Patients with refractory symptoms should be referred for more invasive management such as mechanical devices, injections of bulking agents, onabotulinumtoxin A injections, neuromodulation, sling procedures, or urethropexy. Pharmacologic therapy for urge incontinence includes antimuscarinic medications and mirabegron. Food and Drug Administration for treatment of stress incontinence. Pelvic floor strengthening and lifestyle modifications, including appropriate fluid intake, smoking cessation, and weight loss, are first-line recommendations for all urinary incontinence subtypes. A step-wise approach to treatment is directed at the urinary incontinence subtype, starting with conservative management, escalating to physical devices and medications, and ultimately referring for surgical intervention. ![]() Urinalysis should be ordered for all patients. Helpful tools during initial evaluation include incontinence screening questionnaires, a three-day voiding diary, the cough stress test, and measurement of postvoid residual. ![]() Initial evaluation should include determining whether incontinence is transient or chronic the subtype of incontinence and identifying any red flag findings that warrant subspecialist referral such as significant pelvic organ prolapse or suspected fistula. No other major organization endorses screening. The Women's Preventive Services Initiative is the only major organization that recommends annual screening for urinary incontinence in all women despite low to insufficient evidence regarding effectiveness and accuracy of methods. Urinary incontinence is a common problem among women worldwide, resulting in a substantial economic burden and decreased quality of life.
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