Which clinical history findings are characteristic of urinary incontinence?

Updated: Mar 19, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

The clinical presentation of urinary incontinence can be varied in many respects. Patient complaints may be minor and situational or severe, constant, and debilitating. When obtaining a clinical history, determining whether the problem is a social and/or hygienic problem and the degree of disability attributable to the incontinence also is important. In addition, the following points regarding the clinical presentation should be sought when obtaining the history:

  • Severity and quantity of urine lost and frequency of incontinence episodes

  • Duration of the complaint and whether problems have been worsening

  • Triggering factors or events (eg, cough, sneeze, lifting, bending, feeling of urgency, sound of running water, sexual activity/orgasm)

  • Constant versus intermittent urine loss and provocation by minimal increases in intra-abdominal pressure, such as movement, changes in position, and incontinence with an empty bladder

  • Associated frequency, urgency, dysuria, pain with a full bladder, and history of urinary tract infections (UTIs)

  • Concomitant symptoms of fecal incontinence or pelvic organ prolapse

  • Coexistent complicating or exacerbating medical problems

  • Obstetrical history, including difficult deliveries, grand multiparity, forceps use, obstetrical lacerations, and large babies

  • History of pelvic surgery, especially prior incontinence procedures, hysterectomy, or pelvic floor reconstructive procedures

  • Other urologic procedures

  • Spinal and CNS surgery

  • Lifestyle issues, such as smoking, alcohol or caffeine abuse, and occupational and recreational factors causing severe or repetitive increases in intra-abdominal pressure

  • Medications

Patients with coexisting pelvic organ prolapse may report dyspareunia, vaginal pain upon ambulation, and a bulging sensation in the vagina. Patients with severe pelvic organ prolapse may experience herniation of pelvic organs out of the vaginal introitus, necessitating manual reduction of the uterine cervix or vaginal splinting during bowel movements.

Patients with symptomatic rectoceles report severe constipation, often necessitating digital disimpaction. Severe cystoceles may drag both ureters through the true pelvis as the bladder herniates out of the vagina, causing renal azotemia. Bilateral hydroureteronephrosis is due to compression of the ureters against the bony pelvic inlet, resulting in ureteral obstruction.


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