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A systematic search of the medical literature was performed in May 2007. The search, limited to human subjects and journals in English language, included the National Guideline Clearinghouse, the Cochrane database, PubMed, and UpToDate®. The most recent national guidelines for urinary incontinence were created in 1996 and are considered to be outdated. No revised national guidelines were available at the time of publication.

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Urinary incontinence (UI) is the involuntary loss of urine1 and results from several different etiologies that may or may not present in combination with one another. Prevalence data for UI vary significantly across the literature; however, evidence shows that UI increases with age and is generally more prevalent in women.2

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Many individuals suffering from UI attempt to cope with the condition without seeking medical intervention. This may be a result of the social stigma associated with UI or the misconception that UI is a normal part of aging.3 UI is a medical condition that warrants evaluation and individualized management. Quality of life in individuals suffering from UI is diminished when compared with those without incontinence4; successful treatment of UI is the ultimate goal of therapy whenever feasible.

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UI is classified on the basis of the duration and onset of symptoms. Accurate diagnosis is essential to ensure that the most appropriate treatment strategies are initiated. There are two general types of UI: acute and persistent (or chronic). Acute UI is associated with a new or recent medical condition that can be treated independently from the resultant UI. Persistent UI is either not caused by a new treatable medical condition or persists over a long period of time. As described in the following sections, persistent UI is divided into subtypes on the basis of etiology: urge urinary incontinence (UUI), stress urinary incontinence (SUI), mixed UI, chronic retention of urine (formerly overflow UI), and functional UI.

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Acute UI

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Acute UI (or reversible UI) may present independently or in conjunction with long-standing UI. There are numerous causes or contributing factors for UI. A couple of useful mnemonics for identifying possible reversible causes are listed in Table 32-15.

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Table Graphic Jump Location
Table 32-1. Acronyms for Potentially Reversible Causes of Urinary Incontinence
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Urge Urinary Incontinence

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UUI results from an overactive bladder (OAB), a syndrome in which the detrusor involuntarily contracts, either provoked or spontaneously, causing a sudden “urge” ...

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