Urinary Incontinence For Health Professionals: Screening

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Urinary Incontinence for Health Professionals: Screening

First step

You meet with a post-menopausal patient in your office. Even if urinary incontinence is not one of the reasons she's coming to see you, you need to ask her, "Do you ever experience involuntary urine leakage? Do you wear pads to protect yourself from urine loss?"

Embarrassment can be so significant that women may choose to wear absorbent undergarments or pads instead of talking about urinary incontinence.

You can tell them:

  • Urinary incontinence is not necessarily part of normal aging. Identifying what type of urinary incontinence is occurring makes it possible to suggest appropriate and effective treatment.
  • One out of two women suffers from urinary incontinence after the age of 65.
  • 80% of urinary incontinence cases can be improved or cured.
  • Urinary incontinence is a medical condition that can be treated.
  • The sooner treatment begins, the less severe the social consequences will be.
  • Treating incontinence prolongs people's autonomy as they age.

Second step

If there is a problem with urine loss, follow up with a detailed history and a physical exam.

Evaluation of a female patient with urinary incontinence

HISTORY

Duration of symptoms

Frequency and quantity of leakage; timing of incontinence episodes

Circumstances surrounding incontinence (associated with urinary urges, sneezing, coughing, caffeine, alcohol, exercise, changes in position, the sound of water, sexual relations)

History of pregnancy and type of childbirth

History of abdominal or pelvic surgery

History of dementia, mobility problems

Problems with constipation, fecal incontinence

Impact on private and social life (at work, within family and couple relationships)

Medications that may contribute to urinary incontinence

  • some anticholinergics
  • antidepressants
  • antipsychotics
  • hypnotics/sedatives
  • antihistamines
  • narcotics
  • alpha-adrenergic agonists
  • diuretics
  • angiotensin conversion enzymes (if they cause coughing)
  • oral estrogens

Nutrition and hydration profile

Environmental situation

PHYSICAL EXAM

Observe the patient's mobility and dexterity

Cystocele

Pelvic prolapse

Atrophic vaginitis

Check for weakness of the pelvic floor muscles

Neurological exam: localizing signs, cognitive function, frontal release signs

Examination of sacral nerves S2-S4 (sensitivity around the anus, anal muscle tone, anal and bulbocavernous reflexes)

Constipation

TESTS

Cough stress test

PVR (post-void residual urine volume) by echography or catheterization (abnormal> 100 cc)

Hypercalcemia, hyperglycemia

Urine analysis and culture

Cystoscopy if there is hematuria

Urodynamic tests if diagnosis is unclear or surgery is recommended

Voiding diary (time, circumstance, urgency)

 Next: Reversible Causes

 

We are pleased to house this series of FAQs for health professionals, supervised by Cara Tannenbaum, from the Centre de recherche de l’Institut universitaire de gériatrie de Montréal.

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