Assessment
Table 2. History and General Assessment
>> Nature/duration of genitourinary and lower GI tract symptoms (eg, frequency, volume,
precipitants to/timing of incontinence)
>> Problem with urine storage (eg, urgency, frequency, urge incontinence)
>> Problem with emptying urine (eg, hesitancy, dribbling, weak stream, sense of post-void fullness)
>> Previous pelvic procedures affecting genitourinary tract
>> Comorbidities (eg, congestive heart failure, pulmonary disease, nephrolithiasis)
>> Pregnancy history and mode of delivery
>> Bowel dysfunction (eg, constipation, difficult defecation, fecal incontinence)
>> Medications (eg, affecting urinary retention/frequency) (Table 6)
>> Impact of incontinence on quality of life, including sexual function
>> Sociocultural and environmental issues
>> Patient mobility and access to bathroom
>> Patient goals/expectations of treatment
>> Mental status affecting ability to understand management plans/treatment options
>> Patient fitness for possible surgical treatment
For frail/elderly patient, emphasis on DIAPPERS:
>> Delirium
>> Infection
>> Atrophic vaginitis
>> Pharmaceuticals
>> Psychological
>> Excess urine output
>> Reduced mobility
>> Stool impaction and other factors
Table 3. Physical Examination
>> General assessment of cognitive function, flexibility, ambulation
>> Back: assess for costovertebral angle tenderness, surgical scars
>> Abdominal: assess for surgical scars, muscle strength, hernia, mass, post-void palpable bladder
>> Pelvic and speculum: assess for skin breakdown; sensation; pelvic support defects (with
Valsalva maneuver); atrophy; levator muscle tone, symmetry and strength; evidence of fistula
>> Rectovaginal: fecal staining, sphincter integrity and tone, consistency of stool, disruption of
perineal body and rectovaginal septum
>> Neurological: sensory and reflexes of sacral segments 2-4 (bladder and urethra, rectum, and
anal canal), lower limbs, gait, cognitive function
>> Stress test for urinary incontinence
>> Tests: urinalysis, urine culture (if indicated), post-void residual urine volume