Types of incontinence and clinical assessment

Urinary incontinence is the involuntary loss of urine. This is a common condition that can lead to a significant impairment in quality of life. There are several types of urinary incontinence. Stress urinary incontinence (SUI), the most common form in women, is the involuntary leakage of urine on exertion or when coughing or sneezing. Involuntary loss of urine accompanied by or immediately preceded by urgency, is termed urge urinary incontinence (UUI). Some women will experience both stress and urge symptoms and have mixed urinary incontinence (MUI). Systematic clinical assessment is important in determining the most appropriate management of women complaining of urinary incontinence. An accurate history will help differentiate between symptoms of stress incontinence, urgency and urge incontinence and assess factors contributing to these problems. A general physical examination should be performed and should include pelvic assessment for genital prolapse and pelvic-floor muscle tone. Several basic investigations can be initiated in the primary care setting and include urinary dipstick analysis to exclude urinary tract infection and frequency volume diary-keeping to assess fluid intake/output and incidence of leakage. In uncomplicated SUI or UUI, women may be empirically managed. For example, women with SUI may benefit from physiotherapy input on pelvic-floor muscle exercises. Women with mixed incontinence, with significant genital prolapse and/or symptoms such as persistent haematuria or bladder pain should be referred to a specialist for further investigation.