Diagnostic step

a. anamnesis

patient identity
Main complaint
Since When is a complaint felt
Three Incontinence Questions (3IQ)
Did you leak urine:
When performing physical activity, such as coughing, sneezing, lifting, or exercise?
[indicates stress incontinence]
When you had the urge or feeling that you needed to empty your bladder, but could not
get to the toilet? [indicates urge incontinence]
Without physical activity or a sense of urgency? [indicates a cause other than stress or
urge]

Is there pain when urinating

Often wet bedtime or not
Other symptoms related
History of diseases so far: diabetes, hypertension, UTI, hematuria
previous operations
The drugs are often consumed
Living habits, eat and drink: coffee, sweet tea, alcohol, etc.
sexual life

b. Physical examination

General conditions
vital signs
Head to toe examination
Inspection of the external genitalia
Palpation Abdomen: No tumor or not, bladder palpable / no
Rectal toucher: fingered prostate hypertrophy, determining the strength of sphincter tone

and pelvic floor muscles

neurological examination
Examination of the urethra meatus while coughing / time while a full bladder (Cough
stress test).

c. Supporting investigation

Laboratory: Urinalysis to determine the presence of infection or not, hematuria, pyuria.

Blood: Blood sugar, kidney function.
Measuring post-micturition residual urine: USG, or directly to the catheter
Urodynamic evaluation / uroflow: assessing the detrusor muscle strength
Urethro cystoscopy: see the state of the bladder and urethra.

Approach to the diagnosis of urinary incontinence

Systematically by means of anamnesis, physical examination and then by investigation sought
factors incontinence. In history also evaluated the fluid intake patterns of patients, oral
medications (diuretics, psychotropic, anticholinergic), certain diseases (diabetes mellitus, stroke,
dementia, etc.) dangejala relating to saluranurin (dysuria, urinary disorders).
All the time and amount of voiding of urine, and the incidence of urinary incontinence should be
noted for 2-7 days. These records can provide valuable diagnostic key. For example,
incontinence that occurs only between the hours of 8:00 until noon may be caused by diuretics
taken the morning.
The physical examination includes examination of the abdomen, rectum and genitals to look for
an enlarged prostate or bladder or nerve disorders sacrum. In elderly patients an elderly / frail to
note the status of mobility and mental status as it relates to the occurrence of urinary
incontinence. Bladder palpable on physical examination may indicate overflow incontinence due
to bladder outlet obstruction or bladder not contarction . Great cystocele showed stress
incontinence, overflow incontinence hypesthesia perianal show due to denervation sacred. Their
parkinsonism or a history of stroke directs the possibility of an urge incontinence due to bladder
instability.
The following approaches may be relatively non-invasive, accurate, cost-effective and well
tolerated. The first stage is to identify the type of overflow incontinence (residual urine greater
than or equal to 450 ml), when clinically appropriate, the patient may be referred keahliurologi
and can be catheterized. For the remaining 90-95% of patients depending on the sex of the
patient. Because of obstruction are rare in female patients, diagnosis is generally between stress
incontinence or detrusor over activity. Leakage due to stress or pressure to look for examination
by asking questions to the patient, if the patient is elderly woman's feeling that the bladder is full,
asked to rest and cough with strong immediately so that leaks can be readily observed. Not only

regular leakage during stress maneuvers performed is strong evidence that it is not a stress
incontinence.
In men, the type of stress urinary incontinence is rare. The problem that usually occurs is
distinguishing detrusor overactivity with obstruction. The next stage is to look for the possibility
of hydronephrosis in men with residual urine exceeds 200 ml, and refer him or empty the bladder
(decompression). When hydronephrosis is not found but there is obstruction, the patient referred
for the possibility of surgery. For another, in patients with symptoms of urge incontinence
allegedly due to detrusor overactivity can be given the treatment. Medications to relax the
bladder should be avoided in patients with residual urine of 150 ml or more. The same approach
is also recommended in patients with cognitive impairment can be observed closely. Patients
elderly man without urge incontinence who failed to empirical therapy, and impaired cognitive
function should be consulted.

Reference:
Kong TK. Clinical Guidelines on Geriatric Urinary Incontinence. Desember 2003.