Differential diagnosis of common female genitourinary complaints.

The symptoms and diagnosis of the three most common female bladder-urethral dysfunctions (infection, stress incontinence, and irritable bladder syndrome) are examined so that the practitioner may better differentiate between these problems and some of their counterparts. Cystitis cystica, urethritis, and radiation cystitis are among the less common infections and are frequently missed. Other conditions can be mistaken for infections: urethral diverticulum, Hunner's ulcer, atrophic vaginitis, urethral stenosis. Stress urinary incontinence, arising from abnormal bladder-urethral unit physiology or from obesity, can benefit from Kegel's exercise to strengthen the external sphincter and pubococcygeus muscles. For irritable bladder syndrome, which is often misdiagnosed, a bladder drill with increasing voiding intervals is useful. Patient understanding of bladder function and the need for retraining is also important.