STRESS INCONTINENCE
Stress incontinence occurs most commonly in women who have had many pregnancies or who are in menopause. The patient loses control of the bladder when he or she coughs, laughs, or sneezes and consequently leaks small amounts of urine. Nocturia is rare in stress incontinence. There is often an associated cystocele. In postmenopausal women, there is often an atrophic vaginitis due to the deficiency of estrogen. Men occasionally develop stress incontinence following a prostatectomy.
DIAGNOSTIC WORKUP
In most cases, the diagnosis will be obvious. You can ask the patient to cough during a vaginal examination, and the urine will trickle out. If that does not establish the diagnosis, have the patient drink a lot of water and not void until he or she returns to the office. Then you can have him or her cough in the recumbent or erect position, and the urine will be released. This is called the stress test. In the Q-tip test, a Q-tip is inserted in the tip of the urethra, and the patient is asked to cough or strain. The Q-tip will move at least 30 degrees above the horizontal in cases of stress incontinence. For further discussion of incontinence, see
page 264
.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
More About Causes of Fecal incontinence
» Next page: DIARRHEA, ACUTE (Algorithmic Diagnosis of Symptoms and Signs)
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