25th July 2023

Assessment/Investigations

• Review medications as a possible cause for symptoms.
• Assess lifestyle factors, i.e., alcohol/caffeine intake, weight.
• Assess functional status, i.e., ability to access the toilet.
• Men: perform a digital rectal examination to assess the prostate and to rule out any other rectal pathology.
• Women: take a full obstetric history. Perform a vaginal/bimanual examination to exclude pelvic organ prolapse and assess the ability to initiate voluntary contraction of pelvic floor muscles, i.e., Kegel’s exercise.
• Urine dip and culture.
• Bladder diary/chart to be recorded by the patient (minimum 3 days).
• Urodynamic studies.
• Imaging: bladder scan (to assess post void residual volume to rule out voiding dysfunction). Ultrasound kidney ureter bladder is indicated in men and women with neurological conditions such as spina bifida/spinal cord injury, where renal complications may occur.

It is important to note that urinary incontinence associated with features suggestive of urological/gynaecological cancer should be referred via the two-week wait pathway. Symptoms to exclude:

• Men: lower urinary tract symptoms complicated with recurrent/persistent UTI, retention, renal impairment, persisting bladder or urethral pain and associated faecal incontinence.
• Women: constant leakage (possible urogenital fistula), previous pelvic radiation therapy, associated faecal incontinence, persisting bladder or urethral pain and pelvic masses.