The assessment of stress urinary incontinence (SUI) is similar to the general assessment performed for urinary incontinence.
The assessment consists of a history, examination and basic investigations including a bladder diary.
History
History taking includes:
- Details of bladder habits e.g. how many times in a 24-hour period toileting occurs
- Details of incontinence such as triggers, frequency, severity, pad usage, effects on quality of life
- Other medical history e.g. of conditions that can affect bladder control such as diabetes, heart failure
- Medications – both prescribed and over the counter
- Fluid intake – especially that of bladder irritants such as coffee, tea, cola drinks, alcohol
- In women – obstetric history
- Past history – of pelvic surgery (e.g. in women – hysterectomy, prolapse or other incontinence surgery) or other urological surgery (e.g. prostate surgery in men), radiotherapy, neurological problems
Physical Examination
The examination includes an examination of the abdomen looking for a distended or enlarged bladder.
In women the examination includes a pelvic (also known as an internal or vaginal examination) to assess the pelvic organs and pelvic floor. A “ cough test” or “stress test” is performed at the time of the pelvic exam to look for stress urinary incontinence. Part of the pelvic examination also includes an assessment of pelvic floor muscle contraction technique and strength.
In men the examination includes a prostate assessment (also known as digital rectal examination).
Basic Investigations
- Testing of the urine for infection and blood or pus cells.
- The Bladder Diary is a very useful tool in both the assessment and treatment of urinary incontinence
- The bladder diary documents frequency of urination and volumes of urine passed over three 24- hour periods (not necessarily consecutive). It is an important tool in quantifying urinary symptoms, helping establish a baseline of symptoms and assessing the effectiveness of treatments.
- More complex testing such as a urodynamic study and cystoscopy is NOT required before starting conservative treatment (such as pelvic floor physiotherapy) in SUI. Indications for urodynamic study and cystoscopy are discussed.
- Urodynamic studies are performed in people considering surgical intervention for stress urinary incontinence to help guide the choice of procedure and to assess bladder function.
