How to Assess Urinary Incontinence in a Woman

In Episode 33 of Med School Question of the Week for USMLE, Alisa Khomutova, MedSchoolCoach expert tutor, answers this medical school question: A 59-year-old multiparous woman comes to the physician because of a urinary leakage for the past 10 months. She involuntarily loses a small amount of urine after experiencing a sudden cramping sensation in the bladder. She often has difficulty making it to the bathroom in time. She has been woken up several times at night by a strong feeling over her bladder being full. She denies burning, itching, hematuria, abdominal pain, or pelvic pain. Menopause was 9 years ago, and she is not on hormone replacement therapy. She works as a night nurse, and drinks 3-4 cups of coffee at work. Upon physical examination, there is no subrapubic tenderness. Pelvic examination is normal and Q-tip test is negative. Ultrasound of the bladder shows a normal post-void residual urine. Which of the following is the primary underlying etiology for this patient’s urinary incontinence?

• Stress Incontinence
• Urinary Tract Infection
• Decreased pelvic floor muscle tone
• Increased urine bladder volume
• Increased detrusor muscle activity