Ask about aforementioned symptoms, medications, medical history (diabetes mellitus, neuropathies)

Pelvic exam: Check for cystoceles, urethroceles, and atrophic changes. Rectal exam: Check for impaction, and rectocele; assess sphincter tone. Neuro exam: Assess for neuropathy.


Urinalysis and culture to rule out urinary tract infection Q-Tip Test

A cotton swab is placed in the urethra. The change in angle between the Q-tip and the woman's body is measured upon straining. Normal upward change is < 30°, and a positive test is one with > 30° change. A positive test indicates stress incontinence.


Cystometry provides measurements of the relationship of pressure and volume in the bladder. Catheters that measure pressures are placed in the bladder and rectum, while a second catheter in the bladder supplies water to cause bladder filling. Measurements include residual volume, pressures at which desires to void occur, bladder compliance, flow rates, and capacity. Diagnoses: Stress, urge, and overflow incontinence.

Urodynamic Studies

A set of studies that evaluate lower urinary tract function. Studies may include cystometry (see above), bladder filling tests, cystoscopy, uroflowmetry leak-point pressure tests, to name a few. Can help diagnose all types of incontinence.

Remember to examine for prolapse while patient is standing.

Q-tip test: Increased upwards motion of the Q-tip is caused by loss of support from the urethrovesicular (UV) junction, indicating stress incontinence.

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