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Incontinence History

 

 

Introduction

 

This article aims to describe the basic concepts of taking a history from a patient with incontinence. This article deals with male incontinence, please refer to this article for an overview of female incontinence. Despite this, there are many common elements shared between male and female incontinence histories...

 

  • Greet the patient, introduce yourself and clarify your role;
  • Check patient details - ascertain that this is the patient whom you expect to see;
  • Emphasise that will you maintain confidentiality & respect - especially important given the embarrassing nature of some of the symptoms;
  • Initiate the consultation - you can start open questions such as, "So what's brought you in today?", [1].

 

History of Presenting Complaint

 

The patient's initial opening sentences may give you some idea of what is going on, and you will need to clarify most of their statements in terms of the regularity of the problem.

 

Try and get a feel of how it's affecting their day-to-day life - you may not see it as much of a problem to get up twice in the night to visit the toilet, but imagine if that's every night for the rest of your life. No wonder if the patient looks a bit tired!

 

It's also often a good idea to clarify what's made them present to you today - what has changed, [2]?

 

Some questions that may help you identify a particular cause:

 

History Taking

 

A summary of useful questions to elicit a satisfactory urology history, (adapted from [2-10]):

 

A summary of useful urology history questions

Past Medical History

 

A full review of the patient's medical history should be taken. Relevant conditions to pay particular attention to are:

 

  • Occupational history - exposure to chemical carcinogens is possible in those employed in chemical and rubber industries, increasing the risk of bladder carcinoma.
  • Neurological disease, diabetes, hypertension or trauma to the back may be relevant, with potential for renal and bladder complications.
  • Any abdominal surgery, especially recently?
  • Needed catheterisation at any point? Any difficulties with this? Do they self-catheterise at home, [8]?

 

Female

  • Obstetric history;
  • History of recurrent UTIs, [9].

 

Male

  • Prostate surgery history;
  • Trans-urethral procedure history - eg TURP (Trans-Urethral Prostatectomy - obviously related to above);
  • Last time they had PSA (Prostate Specific Antigen) checked?
  • Ever had a DRE (Digital Rectal Examination - "a check up on the back passage") performed? What was the result, [4]?
  • If you suspect prostate pathology, download and use the *** IPSS official scoring tool [10] ***

 

General Review

 

Again, a normal systems review, drug and social history should be undertaken, but some particular points to make sure you check are:

 

  • Any recent change in the bowel habit?
  • Have they noticed any sexual dysfunction?
  • How does this affect their quality of life, [3]?

 

  • Has any medication contributed to their symptoms? Diuretics are especially important here!
  • What other medication are they on?
  • How much do they drink in a day?
  • How much of this is caffeinated (tea/coffee/coke), [9]?

 

  • Where are the toilets in their house/place of work/wherever they are symptomatic?
  • Anything stopping or slowing them gaining access, such as stairs that take a long time to climb, doors that are difficult to open, [3]?

 

All of the above history sections are important to elicit as there is much overlap between the different types of incontinence (see diagram below) and a strong urology history can often produce a list of classic symptoms nearly pathogenomic of a particular diagnosis.

 

Ending

     

    • Recheck key facts and timeline.
    • Check for any further concerns on the part of the patient that they haven't mentioned previously!
    • Conclude, outline what is going to happen next, and thank the patient.

     

     

    Further reading

     

    The following PatientPlus articles on Patient UK are a good reference resource:

     

     

     

    References

    [1] http://www.medicine.manchester.ac.uk/cbme/tutornotes/calgarycambridgeframework.pdf

    [2] Thomas,J. Monaghan, T. Oxford Handbook of Clinical Examination and Practical Skills. Oxford University Press 2007

    [3] http://www.patient.co.uk/doctor/Urinary-Incontinence.htm 

    [4] http://www.patient.co.uk/showdoc/40024560 

    [5] http://www.patient.co.uk/doctor/Urinary-Frequency.htm

    [6] http://www.patient.co.uk/doctor/Chronic-Urinary-Retention.htm 

    [7] http://www.patient.co.uk/doctor/Acute-Urinary-Retention.htm 

    [8] http://www.patient.co.uk/doctor/Dysuria.htm

    [9] http://www.patient.co.uk/doctor/Lower-Urinary-Tract-Symptoms-(LUTS)-in-Women.htm

    [10] http://www.gp-training.net/protocol/docs/ipss.doc

     

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