Practical approach to the diagnosis of urinary incontinence

Althouth there have been many diagnostic and technologic advances over the past decade, the practice of medicine remains both a science and an art. Most diagnoses can be ascertianed with a detailed history and physical examination. The history establishes precisely what the patient's chief complaint is. It is important to determine the specific nature of the symptoms, their frequency and severity. Do the symptoms, in fact, require therapy or is the patient concerned that these symptoms may forebode more serious medical problems? From the clinician's standpoint, it is important to delineate which features of the history suggest an underlying etiology. In addition, are there any historical features that, although not directly related to the patient's chief complaint, nevertheless dictate further evaluation because of their potential impact on prognosis? Finally, a feature that must be taken into account, especially when dealing with urinary incontinence, is the psyche of the patient. Are the patient's concerns and goals realistic? How much of the clinical syndrome can be attributed to psychologic components? What is the day to day function of the patient with these symptoms? Are the reactions of the patient appropriate for the severity of symptoms or is there a component of overreaction? Intimate knowledge of the patient's concerns, goals, and desires will abet the physician in establishing the essential guidelines to make appropriate therapeutic decisions.