Incontinence

Question 1

Sequence of events

Answer 1

Open question
Timeline

Question 2

Symptom Analysis

Answer 2

Onset
Frequency- how often do you pass water
Nocturia- how frequent
Amount- large or small amount
Urge- all of a sudden urge to go, have there been times where you haven’t made it
Stress- any leaks when coughing, straining or walking
Pads- to keep yourself dry? how many in a day? What type do you use?
Access- do you have easy access to a toilet all the time, do you often check where a toilet is before you set off

Question 3

Systems review

Answer 3

Haematuria
Pain- when passing urine, in back, in abdomen
Constipation
NS- any muscle weakness, disability
Constitutional- FWARJNL
GUT (men)- takes a while to start stream, weak or strong stream, stop and start several times, prolonged dribbling, after passing is there still some left to pass
Obstetric history (women)- see gynae history
Prolapse (women)- dragging sensation down below, anything protruding from there when you cough

Question 4

Patients Perspective

Answer 4

Feelings and effect on life
ICE

Question 5

Background

Answer 5

PMH (neurological disorders, previous strokes etc.)
DH (water tablets/diuretics)
FH
SH- tea, coffee, fizzy drinks, hours before bed?,

Question 6

MAKE SURE TO RULE OUT CAUDA EQUINA SYNDROME

Answer 6

This could be their first presentation (they may not have any paraesthesia yet, and pain may only be slight)

Question 7

Stress Incontinence

Answer 7

Weak/damaged pelvic floor or anal sphincter, prolapse

Question 8

Urge incontinence

Answer 8

BPH or prostatic carcinoma
Autonomic neuropathy eg. DM, MS, Parkinsons
Infection
Constipation

Question 9

Investigations

Answer 9

Women;

Bedside- abdominal exam (palpable bladder), PV exam, urine dip and MCS
Specialist- urodynamic studies

Men;

Bedside- PR exam, abdominal exam,
Bloods- FBC UE LFT bone profile (metastases), PSA
Specialist- urodynamic studies, MRI if required