Urinary incontinence in women: diagnosis and management.

Urinary incontinence is a common symptom that can affect women of all ages. It has been estimated that there are more than 3.5 million sufferers in the UK alone. History taking guides the investigation and management of patients by evaluating symptoms, their progression and the impact of symptoms on lifestyle. The onset of urinary symptoms, their duration and their severity should be recorded. The predominant bother symptom, e.g., urgency, urge incontinence or stress incontinence, should be identified. The clinician should also enquire about colorectal symptoms and genitourinary prolapse. Accompanying symptoms that may indicate the possibility of a more serious diagnosis and which require referral, such as haematuria, persistent bladder or urethral pain, or recurrent UTI, can also be identified when taking a urinary history. Clinical examination should include an abdominal examination to exclude abdominal mass or palpable bladder, a bimanual examination to exclude pelvic mass, and a vaginal examination. Neurological assessment of the lower limbs and perineum is required if a neurological cause is suspected. Patients are categorised according to their symptoms into those with stress, mixed or urge incontinence. Women with mixed urinary incontinence, who have an involuntary leakage associated with urgency and also with exertion, are treated according to the symptom they report to be the most troublesome.