Assessment and investigations for urinary incontinence

Assessment of a woman complaining of urinary incontinence includes full urological, gynaecological, medical, surgical and drug histories. General, neurological, abdominal and pelvic examinations are undertaken and with the history, enable a presumptive diagnosis to be formulated. Investigations for incontinence should be selected to suit the individual woman's need. Non-specialist investigations include urine testing, completion of a urinary diary and symptom score, pad testing, measurement of residual urine volume and biochemical tests. Specialist investigations include uroflowmetry, conventional and ambulatory cystometry, urethral pressure profilometry and measurement of urethral electrical conductance and leak point pressure. Imaging using ultrasound, X-ray, magnetic resonance or isotopes is sometimes indicated. While neurophysiological testing has little clinical application, cystourethroscopy is of value in various subgroups of women. Thorough assessment and appropriate investigation together result in an accurate diagnosis which in turn allows appropriate treatment for urinary incontinence to be initiated.