Urinary incontinence-assessment in women: stress, urge or both?

BACKGROUND: The aims of assessing urinary incontinence in women are to define the diagnosis, exclude other pathology and guide management. Treatment can be initiated when urinary incontinence is categorised as stress, urge or mixed incontinence. Once conservative measures have been exhausted, the management of stress incontinence is largely surgical, while that of urge urinary incontinence is largely medical.

OBJECTIVE: This article discusses the clinical assessment of urinary incontinence in women with emphasis on the primary care assessment and indications for specialist referral.

DISCUSSION: History taking is the cornerstone of urinary incontinence assessment and in combination with physical examination allows categorisation of patients into stress, urge or mixed urinary incontinence. Basic assessment includes investigations such as urine testing, bladder residual volume measurement, and a bladder diary. Urodynamic testing is not required in all patients or before initiating conservative treatment. Indications for specialist referral and urodynamic testing are discussed.