Evaluation of Female Urinary Incontinence

, , University of Texas Medical School

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Physical Examination

Watching the patient move onto the examination table may reveal poor exercise tolerance, poor coordination, or unilateral weakness. The abdomen should be evaluated carefully to define any masses, organ enlargement, or tenderness. History of any scars observed may be important if a surgical option is chosen. With the patient in the lithotomy position, a pelvic examination should be performed. To evaluate genital prolapse, a speculum (or single blade of a speculum) may be used to reduce the anterior or posterior vaginal wall to allow full evaluation of each potential component of genital prolapse.[9] Significant enteroceles, rectoceles, or other forms of genital prolapse should be identified prior to any intervention. Evaluation can be done as the patient sits with her legs in the lithotomy position. Occasionally it will be necessary to evaluate prolapse with the patient standing. The presence of genital prolapse or incontinence is tested with the labia manually parted and the patient straining (Valsalva test) followed by coughing. Palpation, also performed during a Valsalva maneuver, is used to evaluate urethral mobility. Urethral palpation may identify a urethral diverticulum or tumor. The degree of vulval atrophy should be observed. Vaginal tone may be assessed when pelvic-floor exercises are being considered as therapy.[15]

Neurologic evaluation includes assessment of the perineum and lower limbs including testing for power, tone, and reflexes. Perineal sensation, anal tone, and bulbocavernosus reflex should be assessed.

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