Basic Evaluation of Urinary Incontinence.

Urinary incontinence is a significant, quality of life health condition affecting millions of women. Incontinence is increasingly common as the population ages, and women present with varying degrees of bother. With basic in-office evaluation, most subtypes of urinary incontinence can be defined, evaluated, and treated. Basic in-office evaluation involves a detailed history with a review of current medical problems and medications, a physical examination, and selective in-office testing.

Prevalence of bowel symptoms in women with pelvic floor disorders.

INTRODUCTION AND HYPOTHESIS: To determine the prevalence of a variety of bowel symptoms in women with pelvic floor disorders METHODS: We reviewed charts of consecutive new patients presenting to our urogynecologic clinic between July 2006 and April 2008. Women completed two bowel symptom questionnaires: (1) a nonvalidated questionnaire inquiring about symptoms of fecal/flatal incontinence, painful bowel movements, difficulties in bowel movement, and the need for splinting and (2) the validated, Colorectal-Anal Distress Inventory (CRADI) subscale of the short form of the Pelvic Floor Distress Inventory. Demographic and clinical information were extracted from patients' charts. RESULTS: Four hundred sixty-three women were included. Only 3% of the women presented with defecatory dysfunction or fecal incontinence as their chief complaint. However, 83% answered affirmatively to the presence of at least one CRADI bowel symptom. The most common bowel symptom was incomplete emptying at the end of a bowel movement (56%), followed by straining to have a bowel movement (55%), and flatal incontinence (54%). CONCLUSIONS: Women rarely seek urogynecologic care primarily for bowel symptoms, although they have a high prevalence of bowel symptoms.

Medical record documentation of peripartum urinary incontinence.

OBJECTIVE: To determine the rate of medical record documentation of urinary incontinence (UI) symptoms during the third trimester of pregnancy and postpartum period. STUDY DESIGN: Third-trimester prenatal patients were invited to participate in an institutional board-approved prospective study. Participants completed the 15-item, validated Medical, Epidemiological and Social Aspects of Aging (MESA) questionnaire. The MESA was readministered to participants during a 6-8-week postpartum visit. Outpatient and inpatient medical records were reviewed to determine whether UI symptoms were documented. RESULTS: One hundred sixty women had antenatal MESA and 90 had postpartum MESAs. Of the 160 women with antenatal MESAs, 118 were symptomatic (73%). Five medical records (3.1%) reflected any assessment of UI. Postpartum, 43% of women were incontinent by MESA. Documentation of incontinence assessment was present in 21% of medical records. CONCLUSION: Medical record documentation of UI symptom screening throughout pregnancy and postpartum rarely occurred in this study population.

Usefulness of urine dipstick in an urogynecologic population.

Urine dipstick alone is insufficient for diagnosing urinary tract infection in patients with pelvic floor disorders.

Peripartum urinary incontinence in a racially diverse obstetrical population.

To determine the rates of urinary incontinence in a racially diverse, tertiary care obstetrical population during the third trimester and postpartum using a validated symptom-screening questionnaire. Third trimester prenatal patients receiving obstetric care at Loyola University Medical Center between March and November 2003 participated in this prospective study approved by the Institutional Review Board. Third-trimester participants completed the 15-item, validated Medical, Epidemiological, and Social Aspects of Aging (MESA) questionnaire and the Hunskaar Severity Index. The MESA was readministered to participants during a 6- to 8-week postpartum visit. One hundred and thirteen women completed antenatal and postpartum MESAs. Seventy-four percent (83 of 113) of the patients in the third trimester were categorized as incontinent. The postpartum incontinence rates decreased to 44% (50 of 113). Twenty-one percent (24 of 113) of the participants after delivery reported pure stress incontinence, 3% (3 of 113) urge incontinence, and 20% (23 of 113) mixed incontinence. Only 4% (5 of 113) of the women developed de novo incontinence postpartum: three reported symptoms of pure stress incontinence and two reported symptoms consistent with urge incontinence. The MESA questionnaire identifies more women with antenatal and postpartum urinary incontinence than currently described in the literature.