Obstetrics and Gynecology/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

History Taking in Female Urinary Incontinence

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

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

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