Detailed history

• urological history:
  • symptoms may be mixed
    
    
  • urinary incontinence can vary from the need to change underwear everyday from a few drops occasionally
    
    
  • irritative symptoms e.g. urgency and urge incontinence, frequency and nocturia - may be caused by detrusor instability or may be an adaptive behaviour secondary to stress incontinence
    
    
  • other causes of irritative symptoms to consider include:
    • chronic urinary tract infection
    • interstitial cystitis
    • bladder carcinoma
    • urogenital atrophy
    • alcohol or caffeine
      
      
  • other causes of frequency include:
    • habit
    • diabetes
    • excessive fluid intake
    • anxiety
    • drugs e.g. diuretics
      
      
  • women may report other symptoms e.g. hesitancy, poor flow, incomplete emptying - causes to consider include neurological (e.g. demyelination), obstruction, drugs (e.g. anticholinergics)
    
    
• obstetric and gynaecological history - gynaecological surgery, pregnancies and types of delivery
  • medical history
    • diabetes can present with polyuria or a UTI
    • stress incontinence can be exacerbated by chronic respiratory disease
    • CCF may cause nocturia
    • irritative symptoms may occur secondary to chronic constipation

Notes (1):

• bladder diaries
  • use bladder diaries in the initial assessment of women with urinary incontinence or overactive bladder. Encourage women to complete a minimum of 3 days of the diary covering variations in their usual activities, such as both working and leisure days
• symptom scoring and quality-of-life assessment
  • use a validated urinary incontinence-specific symptom and quality-of-life questionnaire when therapies are being evaluated

Reference:

• NICE (April 2019). Urinary incontinence and pelvic organ prolapse in women: management