Sandvik H, Hunskaar S, Seim A, et al. Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health 1993;47:497–499.
Quality of Life
Quality of life in persons with urinary incontinence (I-QOL).
Wagner TH, Patrick DL, Bavendam TG, et al. Quality of life of persons with urinary incontinence: development of a new measure. Urology 1996;47:67–72.
Incontinence Impact Questionnaire.
Wyman JF, Harkins SW, Taylor JR, et al. Psychosocial impact of urinary incontinence in women. Obstet Gynecol 1987;70:378–381.
Incontinence Impact Questionnaire (IIQ)-7 (short form).
Uebersax JS, Wyman JF, Shumaker SA, et al. Short forms to assess life quality and symptom distress for urinary incontinence in women. The incontinence impact questionnaire and the urogenital distress inventory. Neurourol Urodyn 1995;14:131–139.
Urge-IIQ.
Lubeck DP, Prebil LA, Peebles P, et al. A health related quality of life measure for use in patient with urge urinary incontinence: a validation study. Qual Life Res 1999;1999: 337–344.
a Donovan JL, Badia X, Corcos J, et al. Symptom and quality of life assessment. In: Abrams P, Cardozo L, Khoury J, et al., eds. Incontinence. Plymouth, UK: Plymbridge Distributors, 2002.
Physical Examination The physical examination of the patient with incontinence should focus on general medical conditions that may affect the lower urinary tract and problems related to urinary incontinence. Such conditions include cardiovascular insufficiency, pulmonary disease, occult neurologic processes (e.g., multiple sclerosis, stroke, Parkinson’s disease, and anomalies of the spine and lower back), abdominal masses, and mobility. Key factors to assess during the physical examination are summarized in Table 26.5. A cotton swab test has poor predictive value for determining either stress urinary incontinence diagnosis or predicting treatment success (36). It is used by some clinicians to determine movement of the anterior vaginal wall with Valsalva. A woman with a fixed nonmobile urethra is a poor candidate for a surgery (such as a Burch colposuspension) designed to elevate the urethra. It is not possible to increase support for an already well-supported urethra.
Table 26.5 Physical Examination of a Woman with Lower Urinary Tract Dysfunction
Levator muscle palpation (symmetry, ability to squeeze)
Test of urethral mobility (e.g., cotton swab test)
Simple (Primary Care It is important to realize that formal urodynamics tests are neither the only nor the most important Level) Tests tests of bladder function. Other simple tests that can be performed in the primary care setting provide useful information to guide patient care.
Voiding Diary A frequency/volume bladder chart (often termed a “bladder diary”) is an invaluable aid in the evaluation of patients with urinary incontinence. A frequency/volume chart is a voiding record kept by the patient for several days. Patients are instructed to write down the time of every void on the chart and measure the amount of urine voided. The time of any incontinent episodes, and the specific activities associated with urine loss, should be recorded. If desired, the patient can be instructed to keep a record of ﬂuid intake. Although the type of intake may guide management suggestions, in most cases volume of intake can be estimated with some accuracy from the amount of urine produced.