Medical History and Physical Exam for Urinary Incontinence in Women
A medical history is the most important part of the examination for urinary incontinence. During the medical history, your doctor will ask you to describe:
- How long you have had incontinence.
- What, if anything, you are doing (laughing, sneezing, coughing) when you experience incontinence.
- How often you have the problem and how much urine you lose.
- Risk factors you may have that could lead to incontinence.
- Your eating habits.
- Your bowel habits, to determine whether chronic constipation may be contributing to incontinence.
- Prescription and nonprescription medicines you take.
- Treatments for previous problems affecting your urinary or reproductive tract.
- Your use of pads or other protective devices to control urine leakage.
The doctor will ask questions about your general health. To find out the cause of your incontinence, he or she will ask specific questions about your urinary and reproductive tracts, your intestines, and your nervous system.
Symptoms and conditions that are often related to incontinence will also be investigated, such as:
- A need to urinate frequently.
- A sudden, strong urge to urinate.
- Inability to urinate.
- A blocked urine stream.
- Leakage of urine while sleeping.
- Possible urinary tract infection.
- Looking for growths, such as tumors, in the pelvic area.
- Checking the pelvic muscle tone.
- Checking that the bladder has not dropped out of its proper position and that it is not pressing on the vaginal wall.
- Checking the nervous system to see if a problem is causing muscle weakness or loss of reflexes.
Why It Is Done
A medical history and physical exam are done for everyone who sees a doctor about urinary incontinence.
- No growths or physical abnormalities are found.
- The pelvic organs (uterus and bladder) have not dropped from their normal position.
- Pelvic muscle tone is firm.
- No abnormal muscle weakness, or reflex loss is due to a nerve problem.
- Constipation or a hard stool is not present.
- Pain or discomfort occurs when the doctor presses on the back or abdomen. (This may suggest a urinary tract infection. Urinalysis and urine culture may be needed.)
- Growths or abnormalities that may be blocking the urinary tract are detected during the pelvic or rectal examination. Ultrasound or computerized tomography (CT scan) may be recommended.
- Pelvic muscle tone is weak, which may be a factor in stress incontinence. A bladder stress test or pad test may be needed.
- Other areas of the body, in addition to the urinary tract, show a loss of muscle control or signs of Parkinson's disease or stroke. Referral to a neurologist may be needed.
What To Think About
The medical history is important and can determine some causes of incontinence.
Be sure to tell the doctor about all prescription and nonprescription medicines you are taking.
The physical exam can find structural abnormalities of the urinary tract that may be causing or contributing to incontinence. Findings from the physical exam help your doctor know whether further testing is needed.