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
