Factors discriminating between genuine stress and mixed incontinence

Nurse practitioners (NP) are often confronted with female clients who describe various types of urine loss symptoms. To establish an accurate diagnosis and therapeutic intervention, it is important for the NP to identify the etiology of the urine loss complaint. The purpose of the study is to compare symptoms and physical findings that differentiate between the urodynamic diagnoses of genuine stress incontinence (GSI) and mixed incontinence (MI) in 135 clinical trial subjects: 123 diagnosed as GSI and 12 as MI. These subjects participated in a randomized controlled clinical trial to investigate the efficacy of biofeedback and pelvic floor exercises for incontinence treatment. Data were analyzed for significant differences between these two groups on urologic and gynecologic symptoms, pelvic muscle relaxation, vaginal mucosa, vaginal electromyograph readings, urodynamic parameters, and quantified measure of urine loss. One-way analysis of variance (ANOVA) showed significant difference in nocturnal and diurnal voidings and urine loss immediately after sensing the urge to void in the MI and GSI subjects. Chi-square analyses found a significantly decreased incidence of poor vaginal tone and atrophic vaginal mucosa in the MI group as compared to the GSI group. The MI group also lost significantly more urine than did the GSI group on the hand wash maneuver of the perineal pad test. Although the sample size of MI subjects was small, these results show that a noninvasive history and physical examination can differentiate between urologic diagnoses. This approach provides a cost-effective expedient protocol to aid the NP in establishing a differential diagnosis between genuine stress and mixed incontinence.