Urinary Incontinence: Medical History

Medical history (history of illness) is an important component in the diagnosis of urinary incontinence (bladder weakness). Family history

Social history

• What is your occupation?
• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

• When does urine leakage occur?
  • Do you have urine leakage when you laugh, sneeze, cough, or engage in physical activity?
  • Do you have urine leakage with imperative (unprompted) urination or frequent urination?
• How strong is the urine output during the day or also at night?
• Are assistive devices needed in the care of urinary incontinence? If so, which aids?

Further questions or answers arise from keeping a micturition diary (urinary diary; see below).In geriatric patients also questions to the accompanying person about the mobility and cognitive function of the patient. Vegetative anamnesis incl. nutritional anamnesis

Self history incl. medication history.

• Pre-existing conditions (chronic diseases of the urinary tract; atherosclerosis (arteriosclerosis; hardening of the arteries), diabetes mellitus, Parkinson’s disease, Z. n. apoplexy (stroke), encephalitides (inflammation of the brain), spinal cord lesions, dementia, depression, other mental illnesses).
• Allergies
• Pregnancies (number, complications)
• Sexual history (if applicable, indications in sexually active men and women, e.g., estrogen deficit (in case of dyspareunia/pain during intercourse), neurological disorders or metabolic diseases (in case of erectile dysfunction, ED/erectile dysfunction).
• Radiotherapy (Radiation)?

Medication (which may cause temporary urinary incontinence).

• Alpha blockers (stress incontinence as a direct side effect).
• Analgesics of the COX inhibitor group (celecoxib).
• Anticholinergics (e.g., disopyramide).
• Antidepressants (e.g., amitriptyline, fluoxetine).
• Antihypertensives (eg, captopril, dihydropyridine, prazosin).
• Anti-Parkinsonian drugs (e.g., trihexyphenidyl).
• Antipsychotics (e.g., haloperidol).
• Diuretics (e.g., furosemide)
• Opiate analgesics
• Oral antidiabetic agents (e.g., rosiglitazone)
• Cytostatic drugs (vincristine* )

* Reversibility possible

Surgical history

• Man:
  • State n. radical prostatectomy (surgical removal of prostate gland with capsule, the end pieces of the vas deferens, the seminal vesicles, and the regional lymph nodes); usually temporary (transient).
  • Zust. n. transurethral resection of the prostate (TUR-P; surgical removal of the prostate through the urethra).
  • Zust. n. Laser treatment of the prostate
  • Zust. n. Adenomenukleation (surgical peeling of an adenoma (enucleation = peeling from the well-defined tissue without entrainment of surrounding tissue).
  • Zust. n. transurethral urethral surgery for urethral stenosis.
• Woman:
  • Zust. n. operations with fistula formation (e.g., vesicovaginal fistula (bladder-vaginal fistula)).
  • Zus. n. vacuum extraction (“suction cup delivery”).

Reference to keeping a daily log

A diary (micturition diary, micturition log; urinary diary; bladder diary) should be kept for 2/14 days with the following entries:

• Frequency of micturition on 2 days
• Micturition volume
  • 1. morning urine
  • Maximum micturition volume (not including 1st morning urine).
  • Average micturition volume (without taking into account the 1st morning urine).
  • Nocturnal urine volume (1st morning urine + nocturnal urine volume).
• Drinking amount/24 h on 2 days
• Time to fall asleep and time to get up
• Complaints such as incontinence, urge or pain.
• Urinary incontinence events in 14 days
• Fecal incontinence events in 14 days

In the elderly patient, specific questions should include complaints related to the lower urinary tract.

• Micturition history (if necessary, external history): this includes:
  • Frequency of micturition (“number of times urinating”) per day.
  • Micturition frequency at night
  • Micturition volume
  • Incontinence quantity and frequency
  • Posture during micturition
  • Starting difficulties
  • Urinary stream quality
  • Continuous/intermittent micturition
  • Use of the abdominal press
  • Dysuria (difficult (painful) urination)/alguria (pain during urination).
  • Hematuria (blood in the urine)

Since bladder emptying disorders and urinary incontinence are often associated with bowel dysfunction, a comprehensive stool history should always be taken as well. This consists of questions about:

• Stool frequency
• Fecal incontinence
• Fecal smearing
• Emptying difficulties
• Advance warning time
• Consistency
• Melaena (tarry stools, i.e., black-colored stools).
• Defecation pain (pain during defecation).

A simple micturition calendar contains the columns:

• Date
• Time
• Drinking quantity (ml)
• Urine quantity (ml)
• Incontinence, other