What is included in the physical exam for urinary incontinence?

Updated: Sep 23, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

A focused physical examination should be performed. The examination is tailored somewhat in each case, based on the specifics of the patient's incontinence complaint and pertinent medical and surgical history. Each patient should have height, weight, blood pressure, and pulse recorded. Obesity is an important contributor to stress incontinence, and the presence of obesity may influence management decisions.

The patient should provide a urine sample for urinalysis and culture. Some practitioners have the patient arrive with a full bladder, measure the volume voided, and then catheterize the patient to obtain a postvoid residual measurement. Others incorporate this step into the urodynamics portion of the evaluation if that is to be performed.

Medical illnesses and comorbidities that may be contributing to the overall incontinence disorder should be sought. Cardiac and pulmonary evaluation can be important. The abdomen should be examined for surgical scars, hernias, masses, organomegaly, and distended bladder after voiding. The presence of hernias may indicate inherent connective tissue weakness, a possible contributor to incontinence. Masses may contribute to stress incontinence and, occasionally, may cause obstructed voiding with resultant overflow incontinence.

The back should be inspected for deformity, dimpling, or hair tuft and the flank and costovertebral angles should be palpated. Tenderness, deformity, or the presence of surgical scars should prompt further investigation.


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