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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.
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Evaluation of a female patient with urinary incontinence |
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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
Nutrition and hydration profile Environmental situation |
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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 |
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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 [2]
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.
Browse Contents of Urinary Incontinence for Health Professionals
- Screening
- Reversible Causes [2]
- Differential Diagnosis [3]
- Treatment Options [4]
Not a health professional? Click here for more information on urinary incontinence [1]