Looses urine when coughs or sneezes

DDx

• overflow
• stress

Multiple peripheral neuropathy indicators + high postvoid residual = overflow

• Patient with history of poorly controlled T2DM with signs of autonomic neuropathy (gastroparesis) presents with intermittent urinary incontinence found to have a post-void residual volume of 500 mL most consistent with overflow incontinence secondary to poor bladder contraction
• Key idea: Post-void residual > 150 mL is a sign of urinary retention
• Key idea: Autonomic neuropathy can be seen in late-stage diabetes and can manifest as problems with esophageal motility (dysphagia), gastric emptying (gastroparesis), intestinal function (constipation), blood pressure (orthostatic blood pressure unresponsive to fluids) and bladder function (acontractile bladder, incontinence)

Parasympathetic innervation of the bladder regulates detrusor muscle contraction and internal sphincter relaxation to allow for voiding urine. Diabetic autonomic neuropathy can cause a neurogenic bladder with decreased ability to sense a full bladder, incomplete emptying, urinary retention, and distended bladder. Patients with a higher bladder than urethral pressure develop overflow incontinence and lose urine until the pressures equalize. The symptoms can occur cyclically both day and night. Physical examination may show a distended bladder with high post-void residual urine volume (>50 ml ).