Scenario: A 30-year-old woman had her third baby by vaginal delivery 2 years ago. She has recently started exercising again. She used to run 5 miles, 3 days per week. She notices now that after running 1 mile she leaks urine and wets her underpants. The other day, she was laughing with her friend and wet her underpants. The worse symptom was last week when she leaked urine during intercourse with her husband.

Question: What is an important red flag to rule out during the diagnosis of urinary incontinence, and why?

Potential answers:

A. Inguinal hernia

B. Urinary tract infection

C. Saddle anesthesia

D. Anxiety and depression

Answer with rationale: B. Urinary tract infection

Urinary tract infection (UTI) is the most important red flag to look for with stress urinary incontinence, as they can have similar symptoms, and UTI development can even be found with sever cases of stress urinary incontinence.

Inguinal hernia will present very differently, commonly as a lump in the inguinal area that alters with pressure and may or may not cause discomfort and pain with activity.

Saddle anesthesia is commonly a red flag for cauda equina syndrome, and presents as numbness and sensation deficits to the groin, buttocks, and upper legs. These symptoms are not similar to those of stress urinary incontinence, and would be most commonly screened for with low back pain.

Anxiety and depression are always important to screen for as a biopsychosocial factor in patients, but are not a red flag directly related to stress urinary incontinence.

For more information see Chapter 279 Stress Urinary Incontinence in The Color Atlas of Physical Therapy.