History Taking in Female Urinary Incontinence
Female Urinary Incontinence is the involuntary loss of urine in the female. There are three types of
urinary incontinence in women:

Genuine stress incontinence - increase in abdominal pressure

Urge incontinence - overwhelming desire to urinate

Overflow incontinence - frequent urinating in small volumes

True incontinence - no control over flow
Epidemiology
Incontinence is a very common problem in women. The prevalence of urinary incontinence in women
differs depending on age:

Young adult women - 20%

Middle-aged women - 30%

Elderly women - 40%
Etiology
Genuine Stress incontinence:

Post-delivery

Post-menopause

Poor control of sphincter
Urge incontinence:

Detrusor instability

Bladder infection

Calculi
Overflow incontinence:

Hypotonic Bladder

Bladder Outlet Obstruction

Pelvic surgery
True incontinence:

Vesiculo-vaginal fistula

Uretero-vaginal fistula

Ectopic ureter

Bladder exstrophy
Presenting Complaint
Urinary Incontinence
History of Presenting Complaint
1. Onset - "When did it begin?"
2. Periodicity - "Is it there every time you go or is it intermittent?"
3. Duration - If episodic - "How long does each episode last?"
4. Severity - "How much urine?"
5. Aggravating factors
6. Relieving factors
7. Associated symptoms

Urgency?

Frequency?

Nocturia?

Hesitancy?

Quality of flow?
Menstrual History
1. Menarche and menopause
2. 1st day of last menstrual period
3. Length of bleeding (days)
4. Frequency
5. Regularity
6. Bleeding between periods
7. Bleeding after intercourse
8. Nature of periods

Heavy?

Clots?

Flooding?
Obstetric History
1. Number of pregnancies
2. Dates of deliveries
3. Induced or spontaneous labor?
4. Mode of delivery
5. Size and sex of the children
6. Complications
Gynecological History
1. Gynecological symptoms
2. Gynecological diagnoses
3. Gynecological surgery
4. Abnormal smears
Past Medical History
1. Current or past illnesses
2. Hospital admissions
3. Past surgeries
Drug History
1. Prescribed medications
2. Non-prescribed medications/herbal remedies
3. Recreational drugs
Family History
1. Medical conditions
2. Gynecological conditions
3. Malignancies
Social History
1. Occupation
2. Support network
3. Smoking
4. Alcohol
Examination
Neurological examination

Sacral reflexes

Lower limb reflexes

Assess cognitive awareness
Abdominal Examination
General Examination
Pelvic examination

Pelvic floor muscles
Investigations
Urinary Dipstick Uinalysis Urinarydynamics
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References
Nitti V W. The Prevalence of Urinary Incontinence. Rev Urol. 2001;3 (S2-S6)
O'Connor, J. Pathology 2nd ed. Mosby. Edinburgh. 2002.
McCarthy, A & Hunter, B (2003) Master Medicine: Obstetrics and Gynaecology (2nd ed.)
Philadelphia: Elsevier Saunder
www.gpnotebook.co.uk