Medical history for urinary problems

A medical history is the most important part of the examination for urinary incontinence. During the medical history, your health professional will ask you to describe:

    * How long you have had incontinence.
    * What, if anything, you are doing (laughing, coughing, or changing posture) when you experience incontinence.
    * How often you have the problem and how much urine you lose.
    * Risk factors you may have, such as ongoing (chronic) bladder infections or prostatitis, that could lead to incontinence.
    * Your eating habits.
    * Your bowel habits, to determine whether chronic constipation may be contributing to incontinence.
    * Prescription and nonprescription medicines you take.
    * Treatments for previous problems affecting your urinary tract.
    * Your use of pads or other protective devices to control urine loss.
    * How much caffeine, alcohol, and other fluids you drink daily.

Your health professional will ask questions about your general health and specific questions about your urinary and reproductive tracts, intestines and nervous system to find clues to the cause of the incontinence. He or she will also ask about conditions that are related to incontinence, including:

    * Prostate cancer.
    * Enlarged prostate (benign prostatic hyperplasia, or BPH).
    * Pelvic surgery.
    * Diabetes.
    * Glaucoma.
    * High blood pressure.
    * Depression.
    * Heart failure.
    * Multiple sclerosis.
    * Amyotrophic lateral sclerosis (ALS).
    * Parkinson's disease.
    * Stroke.
    * Spinal cord injuries.
    * Degenerative disc disease.
    * Previous treatment of urinary incontinence.

Symptoms and conditions that often are related to incontinence also will be investigated, such as:

    * A need to urinate frequently.
    * A sudden, strong need to urinate.
    * An inability to urinate.
    * A blocked urine stream.
    * A loss of urine while sleeping.
    * Signs or symptoms of a urinary tract infection, prostatitis, or enlarged prostate.

A physical examination often includes a thorough abdominal, rectal, and genital examination. The health professional:

    * Looks for growths such as tumors in the pelvic area.
    * Checks for an enlarged prostate or reduced anal muscle tone.
    * Checks to see whether a nervous system problem is causing muscle weakness or loss of reflexes.

Why It Is Done

A history and physical exam are usually done for everyone who sees the doctor about urinary incontinence.

Results
Normal

    * No growths or physical abnormalities are found.
    * The prostate is not enlarged, and there is no evidence of prostate cancer.
    * There is no abnormal muscle weakness or reflex loss because of a nerve problem.
    * You do not have constipation.

Abnormal

    * You have pain or discomfort when the health professional presses on the back or abdomen. This may suggest:
          o A urinary tract infection.
          o A bladder that is full (urinary retention). A catheter (a thin, hollow tube) may need to be inserted to allow urine to flow out of the bladder.
      Other tests such as a urinalysis and a urine culture may be needed.
    * You have an enlarged or very firm prostate gland, which may indicate benign prostatic hyperplasia (BPH) or prostate cancer.
    * Growths or abnormalities were detected during the rectal exam that may be blocking the urinary tract. Ultrasound or computed tomography (CT scan) may be recommended.
    * Other areas of the body, in addition to the urinary tract, show a loss of muscle control or signs of Parkinson's disease or stroke.
The medical history is very important and can determine some causes of incontinence.

Be certain to tell the health professional about all prescription and nonprescription medicines you are taking.

The physical exam sometimes can identify abnormalities in the prostate, abdomen, or nervous system that may be causing incontinence or contributing to it. Findings from the physical exam help determine whether further testing is needed.