History and Physical Examination
A preliminary diagnosis of urinary incontinence can be made on the basis of a history, physical examination
Table 1 lists a few key questions that can provide information on the severity
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|
|Antidepressants,antipsychotics , sedatives/hypnotics||Sedation, retention |
|Diuretics||Frequency, urgency (OAB)|
|Caffeine||Frequency, urgency (OAB)|
|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.
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