Urinary incontinence
O&G
Introduction
Author: Idayat Olawale
As with any history taking it is important to initially exclude any emergency conditions.
For genito-urinary histories relating to incontinence this may largely depend on a patient’s associating features. For instance:
- Cauda equina if associated back pain
WIPER
Wash hands:
Introduction: Introduce yourself by your full name and your role
Patient details: Gather the patient’s full name and DOB
Explain/Establish: Explain what you are going to do and Establish consent
ExPose: Expose & Position the patient if necessary.
Presenting Complaint
Main symptom: Urinary incontinence
History of Presenting complaint:
Use the acronym SOCRATES where applicable
Site-
Onset- When did the incontinence first start?, Has it happened before?
Character- Urge/Stress/Mixed incontinence,
Radiation
Associated features –Pain eg (pelvic/back/flank pain), Pain/stinging/burning on micturition, Foul smelling urine, Fever
Timing – Nocturia
Exacerbating & relieving factors: Lifting heavy materials, sneezing, cough, etc
Severity – impacting day to day life – afraid to leave the house for fear of incontinence
Don’t neglect asking in-depth questions about associated features, eg: regarding the pain, since when have you had back pain? You can again use SOCRATES if applicable. This may help separate acute issues from non-acute ones
Systems review:
A systems review may help identify risk factors which will help to narrow down differentials
For genito-urinary histories ask about previous pregnancies, establish age and weight
Menstruation: Regular/Irregular, Age at Menarche, Date of LMP, Menorrhagia
Obstetrics: Gravida and Parida, Methods of delivery, Any previous complications,
Sexual activity: Is the patient sexually active, One or more sexual partners, Using any contraception, Previous STI screening
Cervical smear: If of age then has the patient had smear tests?, Any previous abnormal results?
Always do a constitutional systems review asking about: Unintentional weight loss, SOB, fevers, fatigue, loss of appetite, pain
Elicit ideas, concerns and expectations using the acronym ICE
Ideas- Do you have any ideas what might be causing this?
Concerns- Is there anything you’re worried about?
Expectations- What are you most hoping for from me today?
Summarise everything the patient has told you to ensure you have correct information or incase anything was missed
Past Medical History
Wash hands:
Introduction: Introduce yourself by your full name and your role
Patient details: Gather the patient’s full name and DOB
Explain/Establish: Explain what you are going to do and Establish consent
ExPose: Expose & Position the patient if necessary.
Medications
Ask about allergies and OTC, herbal or prescribed medications
Family History
For urinary incontinence specify products containing caffeine
Are there any medical conditions that run in the family
Social History
Social history refers to a patient’s sexual activity, smoking, alcohol and drug use, as well as housing, dietary, and occupational status
Tailor these towards whichever history you are undertaking. For genito-urinary histories important factors include: smoking (how many a day and for how long), sexual activity (may have been asked during systems review), Diet and Exercise (caffeine consumption, BMI)
Differential Diagnosis
Separate differentials into most likely, less likely and can’t miss. Each section will differ based on results from the history and examination
Examples of differentials for urinary incontinence include: Weak pelvic floor muscles, Cauda equina, UTI, Diabetes, Over consumption of caffeine/ alcohol, etc
Management
Remember: Bedside --> Laboratory --> Imaging
Bedside examination includes:
Bimanual +/- speculum examination
Laboratory investigations include bloods such as:
STI screen
Urinalysis +/- Urine C+S
Imaging includes:
MRI spine
Bladder scan
Ultrasound
Summarise and present findings from history, exam and lab results
Management plan
Tailor the management based on diagnoses
Discuss with all relevant persons ie: the patient and colleagues