History and Physical Examination
A preliminary diagnosis of urinary incontinence can be made on the basis of a history, physical examination

and a few simple office and laboratory tests. Initial therapy may be based on these findings. If complex conditions are present or if initial treatments are unsuccessful, definitive specialized studies are required. Because urinary incontinence is a common condition, patients being examined for another problem may mention episodes of urinary incontinence.

Table 1 lists a few key questions that can provide information on the severity

of urinary incontinence and help distinguish the major subtypes. If the patient answers affirmatively to these screening questions, a 24-hour "bladder diary" can be given to the patient to complete . The diary entries can then be reviewed at a subsequent office visit.

History
The medical history should also identify such contributing factors as diabetes, stroke, lumbar disc disease, chronic lung disease, fecal impaction and cognitive impairment. The obstetric and gynecologic history should include gravity; parity; the number of vaginal, instrument-assisted and cesarean deliveries; the time interval between deliveries; previous hysterectomy and/or vaginal or bladder surgery; pelvic radiotherapy; trauma; and estrogen status.

Because fecal impaction has been linked to urinary incontinence, a history that includes frequency of bowel movements, length of time to evacuate and whether the patient must splint her vagina or perineum during defecation should be obtained. Patients should also be questioned about fecal incontinence. Patients are even more reluctant to discuss fecal incontinence than urinary incontinence; thus, direct questioning is essential .

Table - 2 Commonly Used Drugs That Can Influence Bladder Function
Drug	Side effect
Antidepressants,antipsychotics , sedatives/hypnotics	Sedation, retention (overflow)
Diuretics	Frequency, urgency (OAB)
Caffeine	Frequency, urgency (OAB)
Anticholinergics	Retention (overflow)
Alcohol	Sedation, frequency (OAB)
Narcotics	Retention, constipation, sedation (OAB and overflow)
Alpha-adrenergic blockers	Decreased urethral tone (stress incontinence)
Alpha-adrenergic agonists	Increased urethral tone, retention (overflow)
Beta-adrenergic agonists	Inhibited detrusor function, retention (overflow)
Calcium channel blockers	Retention (overflow)
ACE inhibitors	Cough (stress incontinence)

A complete list of all prescription and nonprescription drugs that the patient is taking should be obtained. When appropriate, discontinuation of these medications or substitution of appropriate alternative medications will often cure or significantly improve urinary incontinence.