Evaluation

History

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.

Labs

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

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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