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History
Initial Assessment in Women
Detailed History
Identifying the onset and course of UI should be done. The associated
lower urinary tract symptoms include urgency, urinary frequency, nocturia,
hesitancy, straining during urination, interrupted voiding, and incomplete
emptying.
Voiding/Bladder Diary
The patient should be asked to complete a voiding diary that includes the
frequency, volume, timing of incontinence, largest single volume voided and precipitants
to incontinence (eg coughing, sneezing, caffeine, alcohol, exercise, sounds of
running water). The optimum duration of a diary is between 3-7 days.
Other Components of History
Elicit other important information such as history of prolapse, pregnancies
and mode of delivery, past surgeries, sexual function, bowel function
(including constipation and fecal incontinence), prior incontinence therapies such
as pad use (including surgical treatments undertaken), social history (including
smoking and heavy lifting) and their impact on the quality of life.
Medication History
Drugs causing urinary retention with or without urinary frequency are alpha-adrenergic
agonists (eg Pseudoephedrine, Phenylpropanolamine) and anticholinergic
medications (eg tricyclic antidepressants, sedating antihistamines,
Benzatropine, antipsychotics).
Drugs causing stress incontinence include alpha blockers (eg Prazosin,
Terazosin, Doxazosin), ACE inhibitors (if they induce cough), loop diuretics
and alcohol which may overwhelm the ability to get to the bathroom on time. The
use of conjugated equine estrogens increases the risk of developing UI and
worsens pre-existing UI.
Initial Assessment in Men
Initial assessment helps in categorizing UI as stress, urge or mixed UI.
Detailed History
Voiding Diary
Patients should be asked to complete a voiding diary that includes frequency,
volume and timing of incontinence, and precipitants to incontinence (eg
coughing, sneezing, caffeine, alcohol, exercise, sounds of running water).
The optimum duration of a diary is between 24 hours-7 days. Also known
as micturition time charts, frequency/volume charts, bladder diaries
Others
Past surgeries, sexual function, bowel habits (including constipation
and fecal incontinence), impact on quality of life and medication history
should also be evaluated.
Physical Examination
Initial Assessment in Women
A comprehensive physical exam should include examining the general
condition of the patient and a cardiovascular exam to assess the presence of
volume overload. The neurologic exam includes observing the gait and looking
for the presence of muscular atrophy or neurologic deficits. Check vibration
and peripheral sensation for the presence of peripheral neuropathy. Palpate the
abdomen for mass or tenderness.
A genital exam includes inspection of vaginal mucosa for atrophy,
narrowing of the introitus, vault stenosis and inflammation. A bimanual exam should
be done to evaluate presence of masses or tenderness. Check for any pelvic
organ prolapse and determine its degree/stage. Assess whether pelvic support is
adequate or not. Also, check for urethral hypermobility (present in most women
with symptoms of stress UI). An immobile fixed urethra is suggestive of complex
UI and may need further work-up. Check for the presence of cystocele, rectocele
and enterocele. Direct observation of urine loss using the cough stress test
should also be done. A rectal exam can assess sphincter tone and
bulbocavernosus reflex.
Initial Assessment in Men
Abdominal, rectal, sacral, and neurological examinations should be done.
A digital rectal exam will assess the prostate size, shape and consistency and
also check for other rectal pathologies.