What is included in the physical exam in the assessment of bladder dysfunction?

Updated: Jan 04, 2019
  • Author: Gregory T Carter, MD, MS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Physical examination of a patient for incontinence includes cognitive, neural, musculoskeletal, and pelvic assessment. This is because both voluntary and involuntary control of voiding involve the central and peripheral nervous systems as well as the renal and genitourinary systems. Finally, look at the perianal and pudendal skin for incontinence-associated dermatitis and infection.

While engaging with the patient and taking a history, note the presence of cognitive impairment or dementia. Such patients are at risk for incontinence as a consequence of disinhibited bladder contractions.

Determine the motor level of the lesion, including the completeness of the lesion in SCI patients. Ascertain the extent of the patient’s hand function and ability to perform transfers and activities of daily living. Hand function is especially important in SCI patients who are to perform self-catheterization.

Conduct sensory testing to determine the sensory level, especially in SCI patients. Include testing with light touch, pinprick, proprioception, and sacral sensation.

Test reflexes, including normally tested muscle stretch reflexes, the bulbocavernosus reflex, cremasteric reflexes, and anal reflexes. Use the bulbocavernosus reflex to test the integrity of the pudendal nerve and the S2-S4 segments.

Perform pelvic, genitourinary examinations on both male and female patients. For male patients, evaluate the status of the prostate, especially in men aged 60 years or older, as this can cause secondary urologic symptoms such as urinary retention. For female patients, investigate the state of vaginal and bladder supports, particularly in patients with suspected stress incontinence. Relaxation of the bladder neck and weakness of the sphincter mechanism are common in these patients.

Determine the condition of the skin in the perianal area. In patients with chronic neurogenic bladder, the skin typically shows areas of chronic irritation manifested by areas of excoriation and redness, usually superseded by fungal infection.


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