Physical examination
A complete physical examination inclusive of
the nervous system and a relevant mental
examination must be performed. In men and
women attention should be paid to prostate and
pelvic examinations respectively. A digital rectal
examination to evaluate sphincter tone and
exclude faecal impaction is required in both
sexes. The “cough test” to provoke stress
incontinence should be done in an upright
(female) patient and is particularly useful when
the patient has at least 200 cc of urine in the
bladder2. If leakage of urine is immediate, weak
pelvic floor musculature is the cause. If urine
leaks a while after coughing, it’s due to
involuntary bladder contraction induced by the
cough3.
Urine analysis of a clean catch mid-stream
sample should be done on all patients
complaining of incontinence. The post-void
bladder residual urine volume (PVR) can be
checked after micturition. If greater than 400
cc, it is suggestive of DHIC in women and either
bladder outlet obstruction or hypoactive
detrusor in men4. PVR can also be measured by
bladder ultrasound. Involuntary bladder
contractions can be studied using cystometry
and help in diagnosing hyperactive bladder.
Complex urodynamic testing can be done to
evaluate detrusor and urethral sphincter
function, but their description is beyond the
scope of this article. Complex testing will need
specialist referral.