History taking in women with urinary incontinence (UI) allow doctors to guide the investigation and management by evaluating symptoms, their progression and the impact of symptoms on lifestyle. A good clinical history will include enquiries about impact of the disease on quality of life by asking how the symptoms affect aspects of daily life and social, personal and sexual relationships.
When obtaining the woman’s history, the aim should be to explore possible aetiological factors and to enquire about neurological disease, past obstetric trauma and gynaecological and urological surgery. When polyuria is present doctors must ensure that this is not secondary to a pathology, such as diabetes mellitus, diabetes insipidus or hypercalcaemia.
But, most of these women will prove to have primary polydipsia and simple advice on fluid restriction should be sufficient to resolve any problem of urinary frequency. To reach a clinical diagnosis, doctors should take a urinary history to determine storage and voiding patterns and symptoms. Common symptoms are:
• Storage symptoms – frequency (daytime), nocturia, urgency, urge UI, stress UI, constant leakage (which may rarely indicate fistula).
• Voiding symptoms – hesitancy, straining to void, poor or intermittent urinary stream.
• Post-micturition symptoms – sensation of incomplete emptying, post-micturition dribbling.
In addition to these symptoms, it is important to enquire about colorectal symptoms and genitourinary prolapse. Accompanying symptoms that may indicate a more serious diagnosis and which require referral – haematuria, persisting bladder or urethral pain, or recurrent urinary tract infection (UTI) – can also be identified when taking a urinary history.
In current practice women with urinary incontinence are categorised, according to their symptoms, into those with stress, mixed or urge urinary incontinence. Around one half of all incontinent women complain of pure stress incontinence and 30-40 per cent have mixed symptoms of stress and urge incontinence.
Women with mixed UI, defined as an involuntary leakage associated with urgency and also with exertion, are treated according to the symptom they report to be the most troublesome. First treatment should commence on this basis. In mixed urinary incontinence , the treatment should be directed towards the predominant symptom.
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