▪ ICD-9-CM Code 625.6 (Female) o 788.32 (Male) o 788.33 (Mixed) ▪ ICD-10-CM Code N39.3 (Stress incontinence [female] [male]) o N39.3 (Stress incontinence [female] [male]) o N39.46 (Mixed incontinence) Referral to the current editions of the ICD-9-CM and ICD-10-CM coding manuals is recommended to confirm the appropriate code . Symptoms and Signs Stress incontinence is a symptom, a sign, and a diagnosis. It occurs when increased abdominal pressure forces urine through the bladder sphincter. The patient (usually female) experiences leakage of urine on coughing, sneezing, laughing, lifting, or running, without feeling prior urgency. The patient is unable to control the leakage during physical exertion. Patient Screening Although not a urologic emergency, stress incontinence can seem like an emergency for the individual experiencing it. Therefore, when possible, the patient should be scheduled for an appointment as soon as possible. Etiology Weakening of the pelvic floor muscles and the urethral structure causes this embarrassing disorder. Trauma to the area resulting from childbirth is the most common cause. Pressure from an existing pregnancy also may be the cause. The hormonal changes of aging and menopause make the condition more common in older women. Certain medications and obesity can precipitate the disorder. Diagnosis
Unit 7: Urinary and Reproductive Systems The symptoms clearly point to the diagnosis. Endoscopy and voiding cystourethrogram (VCUG) reveal abnormal bladder position, with leakage provoked by coughing or straining, urodynamics . Treatment The treatment consists of exercises ( Kegel exercises , or pelvic floor muscle tightening), estrogen replacement (most effective when estrogen cream is inserted vaginally), drug therapy, surgical repair, or collagen injections. Drug therapy may include tolterodine, Enablex (darifenacin), trospium (Sanctura) or solifenacin succinate (VESIcare). Prognosis Prognosis varies depending on the etiology. Prevention Strengthening pelvic and perineal muscles is helpful. Some females experience stress incontinence as a result of the aging process and normal reduction in the amounts of estrogen produced in their bodies. Medication can control the symptoms in some women; for others there is no prevention. Patient Teaching Patient teaching involves providing information on Kegel exercises and other exercises to strengthen pelvic and perineal muscles. Diet and fluid intake modifications may be discussed. Assistance with locating community resources or other agencies and information is helpful. Suggest locating support groups.
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- Spring '12
- Urinary and Reproductive Systems