Initial Workup and Management for Urinary Urgency

Initial Evaluation

The American Urological Association recommends obtaining a detailed history with comprehensive assessment of bladder symptoms, including time of onset, specific symptoms, and frequency 1
The American College of Physicians suggests determining if symptoms are consistent with urgency UI, stress UI, or mixed UI 2
Assessing the impact on quality of life is crucial, as effects range from slightly bothersome to debilitating, according to the American College of Physicians 2
Identifying risk factors, including pregnancy, pelvic floor trauma, menopause, hysterectomy, obesity, urinary tract infection, cognitive impairment, chronic cough, and constipation, is essential, as recommended by the American College of Physicians 2

The American College of Physicians strongly recommends bladder training as first-line treatment for patients with urgency UI (strong recommendation, moderate-quality evidence) 2, 3
For patients with stress UI, the American College of Physicians strongly recommends pelvic floor muscle training (PFMT) (strong recommendation, high-quality evidence) 2, 3
For patients with mixed UI, the American College of Physicians strongly recommends PFMT combined with bladder training (strong recommendation, moderate-quality evidence) 2, 4

The American College of Physicians recommends weight loss and exercise for obese women with UI (strong recommendation, moderate-quality evidence) 2, 5
Avoiding bladder irritants in diet, such as caffeine and alcohol, is recommended, according to the American Urological Association 1
Treating constipation is essential, as recommended by the American College of Physicians 2

The American College of Physicians recommends pharmacologic treatment if bladder training was unsuccessful for patients with urgency UI (strong recommendation, high-quality evidence) 2, 3
For patients with stress UI, the American College of Physicians does not recommend systemic pharmacologic therapy (strong recommendation, low-quality evidence) 2, 6

The American College of Physicians suggests that tolterodine causes fewer adverse effects than oxybutynin with similar efficacy 6, 5
Solifenacin has the lowest risk for discontinuation due to adverse effects, while oxybutynin has the highest risk, according to the American College of Physicians 5
Common adverse effects of antimuscarinics include dry mouth, constipation, and blurred vision, as reported by the American College of Physicians 5

The American College of Physicians warns against failure to identify medications that may cause or worsen UI 7
Overlooking conditions that may cause UI, such as urinary tract infections and metabolic disorders, is a common pitfall, according to the American College of Physicians 7
Underdiagnosis is common, with at least half of women with UI not reporting the issue to their physicians, as noted by the American College of Physicians 2