A 66-year-old diabetic woman reports constant low-volume urine loss day and night. She feels she cannot empty her bladder fully and strains to void. Examination shows a palpable suprapubic swelling, reduced sensation, and lax perineum. Postvoid residual urine is 700 ml. The most likely type of incontinence is:

• A Continuous incontinence from a vesicovaginal fistula
• B Genuine stress incontinence
• C Urge incontinence from detrusor overactivity
• D Overflow incontinence from an atonic neurogenic bladder ✓

Explanation

Diabetic autonomic neuropathy causes a sensory and motor denervated, atonic bladder that fills to a large capacity without the patient feeling urgency; the raised intravesical pressure then forces small amounts past a closed sphincter, giving paradoxical or overflow incontinence. The huge postvoid residual, straining to void, and absent urge distinguish it from detrusor overactivity and stress incontinence. D fistula gives true continuous leakage with an empty bladder, not a palpable distended bladder with high residual volume.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.