Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

1492 Urinary Incontinence

■Severity of incontinence (type and number of pads [day and night],

Validated Quality of Life Questionnaire to assess the impact of incon-

tinence on daily activities, such as Incontinence Impact Question-

naire [IIQ-7] or Urogenital Distress Inventory [UDI-6])

■Fluid intake (amount and type)

■Past urologic history (childhood and bedwetting problems)

■OB/GYN history (parity and types of delivery and complications –

i.e., lacerations/episiotomies/forceps), symptoms of prolapse or

prior procedures to correct incontinence or prolapse, hormonal

deprivation, dyspareunia

■Bowel habits (constipation, fecal incontinence, vaginal splinting)

■Medical conditions interfering with urinary output (impaired renal

function, diabetes, congestive heart failure)

■Neurological history (multiple sclerosis, Parkinson’s disease, stroke,

etc.)

■Prior surgical history (abdominal, back, brain)

■Medications with urinary side effects (diuretics, sedatives, choliner-

gics or anticholinergic drugs, hormones, and psychotropics)

Signs & Symptoms

A complete exam (abdominal, genital, pelvic, and neurologic) is essen-

tial in the evaluation of all incontinence in women.

■Genital examination: vaginal condition (scar from episiotomy; vagi-

nal atrophy: loss of rugae, thin shiny vaginal wall)

■Urethral meatus: caruncle, condyloma, Skene’s abscess

■Urethra: palpated for scarring or tenderness suggestive of urethral

diverticulum

■Speculum examination looking for cystocele, uterine descent, vault

prolapse, enterocele, or rectocele

■Ask patient to cough and strain, supine and/or standing. Leakage

with effort indicates stress incontinence. Secondary leakage trig-

gered by an effort suggests stress-induced instability.

■Careful neurologic exam

➣Perineal examination (sensation)

➣Bulbocavernosus reflex

tests

Basic Tests

■Lifestyle Questionnaires

■Voiding diary (3–7 days) – diary should include time of voiding, vol-

ume voided, number of pads used per day, leakage episodes and

inciting events