Urinary and Fecal Incontinence

CLINICAL DIAGNOSTIC MANUAL

Urinary and fecal incontinence is a condition characterized by the involuntary loss of urine and/or stool, significantly impacting the quality of life of those affected. This condition can result from a variety of factors affecting sphincter control and the neurological and muscular function of the genitourinary and gastrointestinal systems.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Urinary Incontinence	Constant dribbling, urinary urgency, increased frequency, nocturia	Detailed clinical history, physical examination, urinalysis to detect infections or abnormalities	Urodynamic studies, abdominal and pelvic ultrasound
Fecal Incontinence	Involuntary loss of stool, fecal urgency, soiling	Detailed clinical history, physical examination, evaluation of anal control, and possible gastrointestinal history	Anorectal manometry, colonoscopy
Neurogenic Bladder	Difficulty initiating urination, weak urinary stream, overflow incontinence	History of neurological diseases, bladder dysfunction symptoms	Urodynamic studies, spinal MRI or CT imaging
Epileptic Seizures	Loss of sphincter control during a seizure, postictal confusion	History of seizure episodes, neurological evaluation	Electroencephalogram (EEG), brain MRI
Dementia	Urinary and/or fecal incontinence in advanced stages, cognitive decline, memory loss	Mental status evaluation, detailed clinical history	Neuropsychological testing, brain MRI or CT
Severe Depression	Incontinence associated with apathy or loss of interest, changes in appetite and sleep, persistent sadness	Psychiatric evaluation, use of depression questionnaires	Clinical diagnosis based on DSM-5 or ICD-10 criteria
Fecal Impaction	Loss of liquid stool, abdominal pain, distension, absence of normal bowel movements	History of chronic constipation, physical examination revealing palpable fecal mass	Abdominal X-ray, digital rectal exam
Multiple Sclerosis	Urinary and/or fecal incontinence, muscle weakness, coordination problems, blurred vision	History of fluctuating neurological symptoms, neurological evaluation	Brain and spinal cord MRI, cerebrospinal fluid (CSF) analysis
Spinal Cord Injury	Urinary and/or fecal incontinence, paralysis or weakness in limbs, sensory loss	History of trauma or spinal injury, neurological evaluation	Spinal MRI or CT scan
Stroke	Urinary and/or fecal incontinence, unilateral weakness, difficulty speaking, loss of vision in one eye	Neurological evaluation, use of stroke scales like NIHSS	Brain CT or MRI, cerebral angiography
Diabetes Mellitus	Urinary incontinence due to neuropathy, increased thirst and hunger, unexplained weight loss	History of diabetes symptoms, blood glucose measurement	Hemoglobin A1c, renal function tests
Cauda Equina Syndrome	Urinary and/or fecal incontinence, lower back pain, loss of reflexes, leg weakness	History of acute lower back pain, neurological exam revealing sensory and motor function loss in lower limbs	Lumbosacral spine MRI, comprehensive neurological exam
Pelvic Organ Prolapse	Sensation of heaviness in the pelvis, urinary incontinence, difficulty defecating	Pelvic physical exam, evaluation of urinary and fecal symptoms	Transvaginal ultrasound or pelvic MRI
Previous Pelvic Surgery or Radiotherapy	Urinary and/or fecal incontinence, pelvic pain, pelvic organ dysfunction symptoms	History of prior surgical interventions or radiotherapy treatments	Urodynamic evaluation, imaging studies like MRI or CT scan
Urinary Tract Infection	Urinary urgency, increased frequency, dysuria, pelvic pain	History of urinary symptoms, physical exam revealing suprapubic tenderness	Urinalysis and urine culture
Prostatitis	Perineal pain, dysuria, urinary urgency and frequency, fever in acute cases	History of urinary symptoms and pelvic pain, physical exam including digital rectal exam	Urinalysis, urine culture, prostatic secretion analysis, transrectal ultrasound
Parkinson’s Disease	Urinary and/or fecal incontinence, resting tremor, muscle rigidity, bradykinesia	History of motor and non-motor symptoms, neurological exam	Clinical evaluation based on diagnostic criteria (UK Parkinson’s Disease Society Brain Bank Criteria)
Irritable Bowel Syndrome (IBS)	Occasional fecal incontinence, abdominal pain, changes in stool frequency and consistency	History of recurrent gastrointestinal symptoms, evaluation of bowel habits	Clinical diagnosis based on Rome IV criteria, exclusion tests for other conditions (e.g., blood tests, ultrasound, colonoscopy as indicated)