Obstetrics and Gynecology/Female Urinary Incontinence

Female Urinary Incontinence is the involuntary loss of urine in the female. There are three types of urinary incontinence in women:


 * Genuine stress incontinence - increase in abdominal pressure
 * Urge incontinence - overwhelming desire to urinate
 * Overflow incontinence - frequent urinating in small volumes
 * True incontinence - no control over flow

Epidemiology
Incontinence is a very common problem in women. The prevalence of urinary incontinence in women differs depending on age:


 * Young adult women - 20%
 * Middle-aged women - 30%
 * Elderly women - 40%

Etiology
Genuine Stress incontinence:


 * Post-delivery
 * Post-menopause
 * Poor control of sphincter

Urge incontinence:


 * Detrusor instability
 * Bladder infection
 * Calculi

Overflow incontinence:


 * Hypotonic Bladder
 * Bladder Outlet Obstruction
 * Pelvic surgery

True incontinence:


 * Vesiculo-vaginal fistula
 * Uretero-vaginal fistula
 * Ectopic ureter
 * Bladder exstrophy

Presenting Complaint
Urinary Incontinence

History of Presenting Complaint

 * 1) Onset - "When did it begin?"
 * 2) Periodicity - "Is it there every time you go or is it intermittent?"
 * 3) Duration - If episodic - "How long does each episode last?"
 * 4) Severity - "How much urine?"
 * 5) Aggravating factors
 * 6) Relieving factors
 * 7) Associated symptoms
 * Urgency?
 * Frequency?
 * Nocturia?
 * Hesitancy?
 * Quality of flow?

Menstrual History

 * 1) Menarche and menopause
 * 2) 1st day of last menstrual period
 * 3) Length of bleeding (days)
 * 4) Frequency
 * 5) Regularity
 * 6) Bleeding between periods
 * 7) Bleeding after intercourse
 * 8) Nature of periods
 * Heavy?
 * Clots?
 * Flooding?

Obstetric History

 * 1) Number of pregnancies
 * 2) Dates of deliveries
 * 3) Induced or spontaneous labor?
 * 4) Mode of delivery
 * 5) Size and sex of the children
 * 6) Complications

Gynecological History

 * 1) Gynecological symptoms
 * 2) Gynecological diagnoses
 * 3) Gynecological surgery
 * 4) Abnormal smears

Past Medical History

 * 1) Current or past illnesses
 * 2) Hospital admissions
 * 3) Past surgeries

Drug History

 * 1) Prescribed medications
 * 2) Non-prescribed medications/herbal remedies
 * 3) Recreational drugs

Family History

 * 1) Medical conditions
 * 2) Gynecological conditions
 * 3) Malignancies

Social History

 * 1) Occupation
 * 2) Support network
 * 3) Smoking
 * 4) Alcohol

Examination
Neurological examination
 * Sacral reflexes
 * Lower limb reflexes
 * Assess cognitive awareness

Abdominal Examination

General Examination

Pelvic examination
 * Pelvic floor muscles

Investigations
Urinary Dipstick Uinalysis Urinarydynamics