wikidoc - User contributions [en]

Abdominal angina pathophysiology

2021-07-19T22:22:50Z

Lina Alatta: /* Chronic mesenteric ischemia Pathophysiology */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
Abdominal angina is an unusual cause of intermittent abdominal pain.The term angina is used because the pain develops only after eating, due to diminshed arterial supply that's needed to meet the increased demands to support digestion <ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9781455709991000733/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>. It's due to reduced mesenteric blood flow, the reduced oxygen content of red blood cells distributed via the mesenteric arterial circulation, or mesenteric venous stasis, any of which can lead to tissue hypoxia and ischemic injury<ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9780323063975000587/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>

==Pathophysiology==

*The pathophysiology is similar to that seen in [[angina pectoris]] and [[intermittent claudication]].
*Abdominal angina occurs due to narrowing of the mesenteric vessels that causes decreased blood flow.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Atherosclerotic vascular disease at ostia of the mesenteric vessels is the most common cause of abdominal angina . Superior mesenteric artery occlusion is often found in patients presenting symptomatic occlusive mesenteric ischemia. Patients with abdominal angina are unable to increase flow in the mesenteric vessels in response to eating and that's why they develop postprandial pain.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Low perfusion can cause intestinal injury when mesenteric perfusion pressure is reduced to about 30 mmHg or reduction of 45 mmHg in mean mesenteric arterial pressure. Physiologically, the intestine can compensate for about a 75% decrease in mesentery blood flow for 12 hours without significant injury due to vasodilation of collateral circulation and increased oxygen extraction. But after an extended period of low perfusion or hypoxemia, progressive vasoconstriction leads to diminished collateral flow and subsequently full-thickness necrosis of the intestinal wall and perforation. Reperfusion injury after ischemia can be observed due to the release of toxic byproducts of ischemic injury, free oxygen radicals, and neutrophil activation.<ref name="urlBowel Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK554527/#article-18478.s5 |title=Bowel Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
===[[Acute Mesenteric ischemia]] Pathophysiology===
*Acute mesenteric arterial embolism has usually cardiogenic origin and commonly affects the superior mesenteric artery, it can occur following atrial tachyarrhythmia, congestive heart failure, myocardial ischemia or infarction, cardiomyopathy, and ventricular aneurysm, which results in thrombus formation that can embolizes to cause ischemia. Patients with acute mesenteric arterial thrombosis commonly have an underlying [[atherosclerotic disease]]. Vasospasm in the superior mesenteric artery usually accompanies non-occlusive mesenteric ischemia secondary to cardiac failure, peripheral hypoxemia, or reperfusion injury. Rarely, vasopressors (e.g., cocaine and norepinephrine) and ergotamines may cause non-occlusive mesenteric ischemia. These agents cause vasoconstriction and decreased blood flow in the mesentery, which may result in ischemia of the bowel<ref name="urlAcute Mesenteric Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK431068/ |title=Acute Mesenteric Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.
===[[Chronic mesenteric ischemia]] Pathophysiology===
*The mesenteric circulation consists mainly of three vessels that supply blood to the small and large bowel: the celiac artery, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). Blood flow through these arteries raises within an hour post-prandially due to an increase in metabolic demand of the intestinal mucosa. Diffuse atherosclerosis, often occurring at the origin of these vessels, is the primary mechanism and accounts for 95% of Chronic mesenteric ischemia. Chronic occlusion of a single vessel allows collateral blood flow to compensate, but symptoms do not typically manifest until at least two primary vessels are occluded. Less common causes include [[vasculitis]], [[fibromuscular dysplasia]], and [[radiation]].<ref name="urlChronic Mesenteric Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK430748/ |title=Chronic Mesenteric Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina pathophysiology

2021-07-19T22:21:32Z

Lina Alatta: /* Acute Mesenteric ischemia Pathophysiology */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
Abdominal angina is an unusual cause of intermittent abdominal pain.The term angina is used because the pain develops only after eating, due to diminshed arterial supply that's needed to meet the increased demands to support digestion <ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9781455709991000733/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>. It's due to reduced mesenteric blood flow, the reduced oxygen content of red blood cells distributed via the mesenteric arterial circulation, or mesenteric venous stasis, any of which can lead to tissue hypoxia and ischemic injury<ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9780323063975000587/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>

==Pathophysiology==

*The pathophysiology is similar to that seen in [[angina pectoris]] and [[intermittent claudication]].
*Abdominal angina occurs due to narrowing of the mesenteric vessels that causes decreased blood flow.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Atherosclerotic vascular disease at ostia of the mesenteric vessels is the most common cause of abdominal angina . Superior mesenteric artery occlusion is often found in patients presenting symptomatic occlusive mesenteric ischemia. Patients with abdominal angina are unable to increase flow in the mesenteric vessels in response to eating and that's why they develop postprandial pain.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Low perfusion can cause intestinal injury when mesenteric perfusion pressure is reduced to about 30 mmHg or reduction of 45 mmHg in mean mesenteric arterial pressure. Physiologically, the intestine can compensate for about a 75% decrease in mesentery blood flow for 12 hours without significant injury due to vasodilation of collateral circulation and increased oxygen extraction. But after an extended period of low perfusion or hypoxemia, progressive vasoconstriction leads to diminished collateral flow and subsequently full-thickness necrosis of the intestinal wall and perforation. Reperfusion injury after ischemia can be observed due to the release of toxic byproducts of ischemic injury, free oxygen radicals, and neutrophil activation.<ref name="urlBowel Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK554527/#article-18478.s5 |title=Bowel Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
===[[Acute Mesenteric ischemia]] Pathophysiology===
*Acute mesenteric arterial embolism has usually cardiogenic origin and commonly affects the superior mesenteric artery, it can occur following atrial tachyarrhythmia, congestive heart failure, myocardial ischemia or infarction, cardiomyopathy, and ventricular aneurysm, which results in thrombus formation that can embolizes to cause ischemia. Patients with acute mesenteric arterial thrombosis commonly have an underlying [[atherosclerotic disease]]. Vasospasm in the superior mesenteric artery usually accompanies non-occlusive mesenteric ischemia secondary to cardiac failure, peripheral hypoxemia, or reperfusion injury. Rarely, vasopressors (e.g., cocaine and norepinephrine) and ergotamines may cause non-occlusive mesenteric ischemia. These agents cause vasoconstriction and decreased blood flow in the mesentery, which may result in ischemia of the bowel<ref name="urlAcute Mesenteric Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK431068/ |title=Acute Mesenteric Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.
===[[Chronic mesenteric ischemia]] Pathophysiology===
*The mesenteric circulation consists mainly of three vessels that supply blood to the small and large bowel: the celiac artery, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). Blood flow through these arteries raises within an hour post-prandially due to an increase in metabolic demand of the intestinal mucosa. Diffuse atherosclerosis, usually occurring at the origin of these vessels, is the main mechanism and accounts for 95% of Chronic mesenteric ischemia. Chronic occlusion of a single vessel allows collateral blood flow to compensate, but symptoms do not typically manifest until at least two primary vessels are occluded. Less common causes include vasculitis, fibromuscular dysplasia, and radiation.<ref name="urlChronic Mesenteric Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK430748/ |title=Chronic Mesenteric Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina pathophysiology

2021-07-19T22:00:04Z

Lina Alatta: /* Acute Mesenteric ischemia Pathophysiology */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
Abdominal angina is an unusual cause of intermittent abdominal pain.The term angina is used because the pain develops only after eating, due to diminshed arterial supply that's needed to meet the increased demands to support digestion <ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9781455709991000733/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>. It's due to reduced mesenteric blood flow, the reduced oxygen content of red blood cells distributed via the mesenteric arterial circulation, or mesenteric venous stasis, any of which can lead to tissue hypoxia and ischemic injury<ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9780323063975000587/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>

==Pathophysiology==

*The pathophysiology is similar to that seen in [[angina pectoris]] and [[intermittent claudication]].
*Abdominal angina occurs due to narrowing of the mesenteric vessels that causes decreased blood flow.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Atherosclerotic vascular disease at ostia of the mesenteric vessels is the most common cause of abdominal angina . Superior mesenteric artery occlusion is often found in patients presenting symptomatic occlusive mesenteric ischemia. Patients with abdominal angina are unable to increase flow in the mesenteric vessels in response to eating and that's why they develop postprandial pain.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Low perfusion can cause intestinal injury when mesenteric perfusion pressure is reduced to about 30 mmHg or reduction of 45 mmHg in mean mesenteric arterial pressure. Physiologically, the intestine can compensate for about a 75% decrease in mesentery blood flow for 12 hours without significant injury due to vasodilation of collateral circulation and increased oxygen extraction. But after an extended period of low perfusion or hypoxemia, progressive vasoconstriction leads to diminished collateral flow and subsequently full-thickness necrosis of the intestinal wall and perforation. Reperfusion injury after ischemia can be observed due to the release of toxic byproducts of ischemic injury, free oxygen radicals, and neutrophil activation.<ref name="urlBowel Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK554527/#article-18478.s5 |title=Bowel Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
===[[Acute Mesenteric ischemia]] Pathophysiology===
*Acute mesenteric arterial embolism has usually cardiogenic origin and commonly affects the superior mesenteric artery, it can occur following atrial tachyarrhythmia, congestive heart failure, myocardial ischemia or infarction, cardiomyopathy, and ventricular aneurysm, which results in thrombus formation that can embolizes to cause ischemia. Patients with acute mesenteric arterial thrombosis commonly have an underlying [[atherosclerotic disease]]. Vasospasm in the superior mesenteric artery usually accompanies non-occlusive mesenteric ischemia secondary to cardiac failure, peripheral hypoxemia, or reperfusion injury. Rarely, vasopressors (e.g., cocaine and norepinephrine) and ergotamines may cause non-occlusive mesenteric ischemia. These agents cause vasoconstriction and decreased blood flow in the mesentery, which may result in ischemia of the bowel<ref name="urlAcute Mesenteric Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK431068/ |title=Acute Mesenteric Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina pathophysiology

2021-07-19T21:50:37Z

Lina Alatta: /* Pathophysiology */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
Abdominal angina is an unusual cause of intermittent abdominal pain.The term angina is used because the pain develops only after eating, due to diminshed arterial supply that's needed to meet the increased demands to support digestion <ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9781455709991000733/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>. It's due to reduced mesenteric blood flow, the reduced oxygen content of red blood cells distributed via the mesenteric arterial circulation, or mesenteric venous stasis, any of which can lead to tissue hypoxia and ischemic injury<ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9780323063975000587/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>

==Pathophysiology==

*The pathophysiology is similar to that seen in [[angina pectoris]] and [[intermittent claudication]].
*Abdominal angina occurs due to narrowing of the mesenteric vessels that causes decreased blood flow.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Atherosclerotic vascular disease at ostia of the mesenteric vessels is the most common cause of abdominal angina . Superior mesenteric artery occlusion is often found in patients presenting symptomatic occlusive mesenteric ischemia. Patients with abdominal angina are unable to increase flow in the mesenteric vessels in response to eating and that's why they develop postprandial pain.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Low perfusion can cause intestinal injury when mesenteric perfusion pressure is reduced to about 30 mmHg or reduction of 45 mmHg in mean mesenteric arterial pressure. Physiologically, the intestine can compensate for about a 75% decrease in mesentery blood flow for 12 hours without significant injury due to vasodilation of collateral circulation and increased oxygen extraction. But after an extended period of low perfusion or hypoxemia, progressive vasoconstriction leads to diminished collateral flow and subsequently full-thickness necrosis of the intestinal wall and perforation. Reperfusion injury after ischemia can be observed due to the release of toxic byproducts of ischemic injury, free oxygen radicals, and neutrophil activation.<ref name="urlBowel Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK554527/#article-18478.s5 |title=Bowel Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
===[[Acute Mesenteric ischemia]] Pathophysiology===
*An acute mesenteric arterial embolism is often cardiogenic in origin and primarily affects the superior mesenteric artery (SMA). Preceding events include atrial tachyarrhythmia, congestive heart failure, myocardial ischemia or infarction, cardiomyopathy, and ventricular aneurysm, which results in thrombus formation that later embolizes to cause ischemia. Patients with acute mesenteric arterial thrombosis commonly have a pre-existing atherosclerotic disease. Vasospasm in the SMA often accompanies NOMI secondary to cardiac failure, peripheral hypoxemia, or reperfusion injury. In rare instances, vasopressors (e.g., cocaine and norepinephrine) and ergotamines may cause NOMI. These agents cause vasoconstriction and reduced blood flow in the mesentery, which may result in ischemia of the bowel.

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina overview

2021-07-19T21:45:02Z

Lina Alatta: /* Overview */

__NOTOC__
{{Abdominal angina}}

Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing

==Overview==

*'''Abdominal angina''' (a.k.a. '''[[bowelgina]]''') is postprandial [[abdominal pain]] that occurs in individuals with insufficient blood flow to meet visceral demands. The term ''angina'' is used in reference to [[Angina pectoris|angina pectoris]], a similar symptom due to obstruction of the [[coronary artery]]. The American Heritage Stedman's Medical Dictionary defines abdominal angina (bowelgina) as "Intermittent [[abdominal pain]], frequently occurring at a fixed time after eating, caused by inadequacy of the mesenteric circulation. Also called intestinal angina; bowelgina." <ref>{{cite web | url = http://www.kmle.com/search.php?Search=abdominal+angina | title = ''KMLE Medical Dictionary Definition of abdominal angina'' | author = [http://www.kmle.com The American Heritage Stedman's Medical Dictionary]}}</ref>
*Mesenteric ischemia is a type of peripheral vascular disease that occurs when the blood supply can not meet the metabolic demands of visceral organs. [[Acute mesenteric ischemia]] is a surgical emergency that presents severe abdominal pain which is described as "pain out of proportion to physical examination." However, [[chronic mesenteric ischemia (CMI)]] usually presents with vague abdominal pain that may be difficult to differentiate from other, more common causes of abdominal pain<ref name="urlChronic Mesenteric Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK430748/ |title=Chronic Mesenteric Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina overview

2021-07-19T21:35:56Z

Lina Alatta: /* Overview */

Abdominal angina epidemiology and demographics

2021-07-19T20:28:52Z

Lina Alatta: /* Developing Countries */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
*Although [[mesenteric ischemia (MI)]] is rare medical condition ,it's accounts for 0.1% of all hospital admissions , The mortality rate of [[mesenteric ischemia]] is ranging from 24% to 94%. The incidence of [[colonic ischemia]] is approximately 16 cases per 100,000 person per years, and it is rising by time . [[Ischemic colitis]] is reported for 1 in 2000 hospital admissions.<ref name="urlBowel Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK554527/ |title=Bowel Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

==Gender==
*female to male ratio is 3:1<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.

==Race==
*There's no available data for the incidence and prevalence of abdominal angina among different races<ref name="urlAbdominal Angina: Practice Essentials, Pathophysiology and Etiology, Epidemiology">{{cite web |url=https://emedicine.medscape.com/article/188618-overview?token=Bssv0GM4iTRpgywKhQAntxLBxLWMKs8F6RVmZIX2pV8C1Xo7PEBaacU4ayZORDdoZ2YrxfcTgTduOrPo5fZgXj8J4Sy6P0X21%2BBNBQxExSBBuCIf%2B7cJMIyjtd0l7r9rHw%2Fbj7EPyQmgTpeanTv9Fvlp3YutVAlxDdrMf9BT4d2gE3meS0vhDw2snZD0zlemeSEyqLLlbxpOLCbEocjH61dtEP%2F3ejnoEgZoonqxMwzr4ytOE7VymqXxh7Lht6K2Cm%2F2aBKLIqSqxc47pf73W2uUo1Jk2HCVgNZSleVXtRznt%2FI6udOMXpHYQZhbj6loCe%2B0OVtjkuAZhzOYmLOFR%2B%2FneplvRkU5UODmOxvaCaVFBYRmYmWMcLRXfU%2B36X8MniOfJOD0lXC5hXyQJ4Sd0ur7NnMU8nbZ%2Fo0KdjoysuVJJHvjwAd3DOlrTVqllUAN4H6ieTe6RkXkVM7xwH8MRb%2BL3oKPxhpjg39enL7CsZPfjRQue2yVqu9iHLKinVRJzLZTG%2Bdw6DJKegY78jG%2BXGVcv6sqT76Vt%2F6N4JUs6ebzPerTILALL%2Bu%2B1Uv7N19mpvfIDJVClbtiJX3DsNH7FtmQLf4vorW8Gqu%2FgwQYms1BeLEdtbWgpC7wtUu2myHWtBSlNDcscupzs6%2BWakvzR%2F5N3QhJJw%2BGjlLPRZigEYa5FFa%2FKVJ6P93CnLZAas3uZem1FMcGGkWIuvzQiV25tg%3D%3D#a6 |title=Abdominal Angina: Practice Essentials, Pathophysiology and Etiology, Epidemiology |format= |work= |accessdate=}}</ref>.

== Age ==
*The average age of patients with mesenteric ischemia is slightly older than 60 years, but it has also been reported in younger patients<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.

==Developing Countries==
* There are few reported cases of abdominal angina outside the united states.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina history and symptoms

2021-07-19T06:06:57Z

Lina Alatta: /* History */

__NOTOC__
{{Abdominal angina}}

 

==Overview==

==History==
*The hallmark of abdominal angina, is disabling midepigastric or central [[abdominal pain]] within 10-15 minutes after eating.
*

==Symptoms==

*[[Abdominal pain]]: severe pain that is out of proportion to the physical exam. It usually starts postprandially. In most cases, the pain gradually subsides after a few hours. Because the pain is so severe, most people develop a fear of eating and hence lose weight.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

:*[[Diarrhea]] or [[constipation]]
:*[[Bloating]]
:*[[Vomiting]]
:*Weight loss<ref name="pmid31598442">{{cite journal |vauthors=Bakhtiar A, Yousphi AS, Ghani AR, Ali Z, Ullah W |title=Weight Loss: A Significant Cue To The Diagnosis of Chronic Mesenteric Ischemia |journal=Cureus |volume=11 |issue=8 |pages=e5335 |date=August 2019 |pmid=31598442 |pmc=6778047 |doi=10.7759/cureus.5335 |url=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina history and symptoms

2021-07-19T05:57:42Z

Lina Alatta: /* Symptoms */

__NOTOC__
{{Abdominal angina}}

 

==Overview==

==History==
The hallmark of abdominal angina, is disabling midepigastric or central [[abdominal pain]] within 10-15 minutes after eating.

==Symptoms==

*[[Abdominal pain]]: severe pain that is out of proportion to the physical exam. It usually starts postprandially. In most cases, the pain gradually subsides after a few hours. Because the pain is so severe, most people develop a fear of eating and hence lose weight.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

:*[[Diarrhea]] or [[constipation]]
:*[[Bloating]]
:*[[Vomiting]]
:*Weight loss<ref name="pmid31598442">{{cite journal |vauthors=Bakhtiar A, Yousphi AS, Ghani AR, Ali Z, Ullah W |title=Weight Loss: A Significant Cue To The Diagnosis of Chronic Mesenteric Ischemia |journal=Cureus |volume=11 |issue=8 |pages=e5335 |date=August 2019 |pmid=31598442 |pmc=6778047 |doi=10.7759/cureus.5335 |url=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina epidemiology and demographics

2021-07-19T05:26:25Z

Lina Alatta: /* Race */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
*Although [[mesenteric ischemia (MI)]] is rare medical condition ,it's accounts for 0.1% of all hospital admissions , The mortality rate of [[mesenteric ischemia]] is ranging from 24% to 94%. The incidence of [[colonic ischemia]] is approximately 16 cases per 100,000 person per years, and it is rising by time . [[Ischemic colitis]] is reported for 1 in 2000 hospital admissions.<ref name="urlBowel Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK554527/ |title=Bowel Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

==Gender==
*female to male ratio is 3:1<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.

==Race==
*There's no available data for the incidence and prevalence of abdominal angina among different races<ref name="urlAbdominal Angina: Practice Essentials, Pathophysiology and Etiology, Epidemiology">{{cite web |url=https://emedicine.medscape.com/article/188618-overview?token=Bssv0GM4iTRpgywKhQAntxLBxLWMKs8F6RVmZIX2pV8C1Xo7PEBaacU4ayZORDdoZ2YrxfcTgTduOrPo5fZgXj8J4Sy6P0X21%2BBNBQxExSBBuCIf%2B7cJMIyjtd0l7r9rHw%2Fbj7EPyQmgTpeanTv9Fvlp3YutVAlxDdrMf9BT4d2gE3meS0vhDw2snZD0zlemeSEyqLLlbxpOLCbEocjH61dtEP%2F3ejnoEgZoonqxMwzr4ytOE7VymqXxh7Lht6K2Cm%2F2aBKLIqSqxc47pf73W2uUo1Jk2HCVgNZSleVXtRznt%2FI6udOMXpHYQZhbj6loCe%2B0OVtjkuAZhzOYmLOFR%2B%2FneplvRkU5UODmOxvaCaVFBYRmYmWMcLRXfU%2B36X8MniOfJOD0lXC5hXyQJ4Sd0ur7NnMU8nbZ%2Fo0KdjoysuVJJHvjwAd3DOlrTVqllUAN4H6ieTe6RkXkVM7xwH8MRb%2BL3oKPxhpjg39enL7CsZPfjRQue2yVqu9iHLKinVRJzLZTG%2Bdw6DJKegY78jG%2BXGVcv6sqT76Vt%2F6N4JUs6ebzPerTILALL%2Bu%2B1Uv7N19mpvfIDJVClbtiJX3DsNH7FtmQLf4vorW8Gqu%2FgwQYms1BeLEdtbWgpC7wtUu2myHWtBSlNDcscupzs6%2BWakvzR%2F5N3QhJJw%2BGjlLPRZigEYa5FFa%2FKVJ6P93CnLZAas3uZem1FMcGGkWIuvzQiV25tg%3D%3D#a6 |title=Abdominal Angina: Practice Essentials, Pathophysiology and Etiology, Epidemiology |format= |work= |accessdate=}}</ref>.

== Age ==
*The average age of patients with mesenteric ischemia is slightly older than 60 years, but it has also been reported in younger patients<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.

==Developing Countries==
Internationallly the incidence of abdominal angina is extremely rare. The true incidence is unknown

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina epidemiology and demographics

2021-07-19T04:47:10Z

Lina Alatta: /* Age */

Abdominal angina epidemiology and demographics

2021-07-19T04:46:22Z

Lina Alatta: /* Age */

Abdominal angina epidemiology and demographics

2021-07-19T04:30:55Z

Lina Alatta: /* Overview */

Abdominal angina epidemiology and demographics

2021-07-19T04:27:17Z

Lina Alatta: /* Overview */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
*Although mesenteric ischemia (MI) is rare medical condition ,it's accounts for 0.1% of all hospital admissions , The mortality rate of mesenteric ischemia is ranging from 24% to 94%. The incidence of colonic ischemia is approximately 16 cases per 100,000 person per years, and it is rising by time . Ischemic colitis is reported for 1 in 2000 hospital admissions.<ref name="urlBowel Ischemia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK554527/ |title=Bowel Ischemia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

==Gender==
*female to male ratio is 3:1<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.

==Race==
No data is available for incidence and prevalence of abdominal angina within different races.

== Age ==
The incidence of AMI increases exponentially with age.

It is the cause of acute abdomen in 10% of patients with with age over 70 years{{cite web |url=https://doi.org/10.1016/j.ejvs.2017.01.010 |title=Redirecting |format= |work= |accessdate=}}

==Developing Countries==
Internationallly the incidence of abdominal angina is extremely rare. The true incidence is unknown

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina epidemiology and demographics

2021-07-19T04:17:09Z

Lina Alatta: /* Gender */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
1 % of patients with acute abdomen have Acute Mesenteric Ischemia. {{cite web |url=https://doi.org/10.1016/j.ejvs.2017.01.010 |title=Redirecting |format= |work= |accessdate=}}

==Gender==
*female to male ratio is 3:1<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.

==Race==
No data is available for incidence and prevalence of abdominal angina within different races.

== Age ==
The incidence of AMI increases exponentially with age.

It is the cause of acute abdomen in 10% of patients with with age over 70 years{{cite web |url=https://doi.org/10.1016/j.ejvs.2017.01.010 |title=Redirecting |format= |work= |accessdate=}}

==Developing Countries==
Internationallly the incidence of abdominal angina is extremely rare. The true incidence is unknown

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina pathophysiology

2021-07-17T01:29:10Z

Lina Alatta: /* Pathophysiology */

Abdominal angina pathophysiology

2021-07-16T20:14:37Z

Lina Alatta: /* Overview */

Abdominal angina pathophysiology

2021-07-16T01:12:43Z

Lina Alatta: /* Pathophysiology */

Abdominal angina pathophysiology

2021-07-16T01:03:08Z

Lina Alatta: /* Pathophysiology */

Abdominal angina pathophysiology

2021-07-16T01:00:50Z

Lina Alatta: /* Pathophysiology */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
Abdominal angina is an unusual cause of intermittent abdominal pain. Arterial vascular insufficiency is the cause of abdominal angina.The term angina is used because the pain develops only after eating, due to diminshed arterial supply that's needed to meet the increased demands to support digestion <ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9781455709991000733/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>. It's due to reduced mesenteric blood flow, reduced oxygen content of red blood cells distributed via the mesenteric arterial circulation, or mesenteric venous stasis, any of which can lead to tissue hypoxia and ischemic injury<ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9780323063975000587/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>

==Pathophysiology==

*The pathophysiology is similar to that seen in [[angina pectoris]] and [[intermittent claudication]].
*Abdominal angina occurs due to narrowing of the mesenteric vessels that causes decreased blood flow.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Atherosclerotic vascular disease at ostia of the mesenteric vessels is the most common cause of abdominal angina . Superior mesenteric artery occlusion is often found in patients presenting symptomatic occlusive mesenteric ischemia. Patients with abdominal angina are unable to increase flow in the mesenteric vessels in response to eating that's why they develop postprandial pain.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

It can be associated with:

*[[carcinoid]]
** [[Carinoid]] tumors can synthesis different types of amine and peptides, like serotonin, 5-hydroxytryptophan, ACTH, substance P, motilin, met-enkephalin, P-endorphin, neurotensin, gastrin, and somatostatin, but the agent which responsible for mesenteric vascular ischemia. Many of these substances have action on smooth muscles like substance P, motilin, and neurotensin which might have a role in the development of vascular elastosis.<ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>
** Midgut carcinoids are known to be more endocrinologically active than those arising from the hindgut, which may be the cause of the fact that elastic vascular sclerosis has not been found in the latter <ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>

*[[aortic coarctation]]

*[[antiphospholipid syndrome]]

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina pathophysiology

2021-07-16T00:16:53Z

Lina Alatta: /* Overview */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==
Abdominal angina is an unusual cause of intermittent abdominal pain. Arterial vascular insufficiency is the cause of abdominal angina.The term angina is used because the pain develops only after eating, due to diminshed arterial supply that's needed to meet the increased demands to support digestion <ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9781455709991000733/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>. It's due to reduced mesenteric blood flow, reduced oxygen content of red blood cells distributed via the mesenteric arterial circulation, or mesenteric venous stasis, any of which can lead to tissue hypoxia and ischemic injury<ref name="urlwww.sciencedirect.com">{{cite web |url=https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9780323063975000587/first-page-pdf |title=www.sciencedirect.com |format= |work= |accessdate=}}</ref>

==Pathophysiology==

*The pathophysiology is similar to that seen in [[angina pectoris]] and [[intermittent claudication]].
*Abdominal angina occurs due to narrowing of the mesenteric vessels that causes decreased blood flow.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Atherosclerotic vascular disease at ostia of the mesenteric vessels is the most common cause of abdominal angina . Superior mesenteric artery occlusion is often found in patients presenting symptomatic occlusive mesenteric ischemia. Patients with abdominal angina are unable to increase flow in the mesenteric vessels in response to eating that's why they develop postprandial pain.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

It can be associated with:

*[[carcinoid]]<ref name="pmid16086212">{{cite journal |author=deVries H, Wijffels RT, Willemse PH, ''et al'' |title=Abdominal angina in patients with a midgut carcinoid, a sign of severe pathology |journal=World journal of surgery |volume=29 |issue=9 |pages=1139–42 |year=2005 |pmid=16086212 |doi=10.1007/s00268-005-7825-x}}</ref>
** [[Carinoid]] tumors can synthesis different types of amine and peptides, like serotonin, 5-hydroxytryptophan, ACTH, substance P, motilin, met-enkephalin, P-endorphin, neurotensin, gastrin, and somatostatin, but the agent which responsible for mesenteric vascular ischemia. Many of these substances have action on smooth muscles like substance P, motilin, and neurotensin which might have a role in the development of vascular elastosis.<ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>
** Midgut carcinoids are known to be more endocrinologically active than those arising from the hindgut, which may be the cause of the fact that elastic vascular sclerosis has not been found in the latter <ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>

*[[aortic coarctation]]<ref name="pmid14627320">{{cite journal |author=Ingu A, Morikawa M, Fuse S, Abe T |title=Acute occlusion of a simple aortic coarctation presenting as abdominal angina |journal=Pediatric cardiology |volume=24 |issue=5 |pages=488–9 |year=2003 |pmid=14627320 |doi=10.1007/s00246-002-0381-3}}</ref>

*[[antiphospholipid syndrome]]<ref name="pmid12111088">{{cite journal |author=Choi BG, Jeon HS, Lee SO, Yoo WH, Lee ST, Ahn DS |title=Primary antiphospholipid syndrome presenting with abdominal angina and splenic infarction |journal=Rheumatol. Int. |volume=22 |issue=3 |pages=119–21 |year=2002 |pmid=12111088 |doi=10.1007/s00296-002-0196-9}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina pathophysiology

2021-07-15T23:24:12Z

Lina Alatta: /* Pathophysiology */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==

==Pathophysiology==

*The pathophysiology is similar to that seen in [[angina pectoris]] and [[intermittent claudication]].
*Abdominal angina occurs due to narrowing of the mesenteric vessels that causes decreased blood flow.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*Atherosclerotic vascular disease at ostia of the mesenteric vessels is the most common cause of abdominal angina . Superior mesenteric artery occlusion is often found in patients presenting symptomatic occlusive mesenteric ischemia. Patients with abdominal angina are unable to increase flow in the mesenteric vessels in response to eating that's why they develop postprandial pain.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

It can be associated with:

*[[carcinoid]]<ref name="pmid16086212">{{cite journal |author=deVries H, Wijffels RT, Willemse PH, ''et al'' |title=Abdominal angina in patients with a midgut carcinoid, a sign of severe pathology |journal=World journal of surgery |volume=29 |issue=9 |pages=1139–42 |year=2005 |pmid=16086212 |doi=10.1007/s00268-005-7825-x}}</ref>
** [[Carinoid]] tumors can synthesis different types of amine and peptides, like serotonin, 5-hydroxytryptophan, ACTH, substance P, motilin, met-enkephalin, P-endorphin, neurotensin, gastrin, and somatostatin, but the agent which responsible for mesenteric vascular ischemia. Many of these substances have action on smooth muscles like substance P, motilin, and neurotensin which might have a role in the development of vascular elastosis.<ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>
** Midgut carcinoids are known to be more endocrinologically active than those arising from the hindgut, which may be the cause of the fact that elastic vascular sclerosis has not been found in the latter <ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>

*[[aortic coarctation]]<ref name="pmid14627320">{{cite journal |author=Ingu A, Morikawa M, Fuse S, Abe T |title=Acute occlusion of a simple aortic coarctation presenting as abdominal angina |journal=Pediatric cardiology |volume=24 |issue=5 |pages=488–9 |year=2003 |pmid=14627320 |doi=10.1007/s00246-002-0381-3}}</ref>

*[[antiphospholipid syndrome]]<ref name="pmid12111088">{{cite journal |author=Choi BG, Jeon HS, Lee SO, Yoo WH, Lee ST, Ahn DS |title=Primary antiphospholipid syndrome presenting with abdominal angina and splenic infarction |journal=Rheumatol. Int. |volume=22 |issue=3 |pages=119–21 |year=2002 |pmid=12111088 |doi=10.1007/s00296-002-0196-9}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina pathophysiology

2021-07-15T23:19:58Z

Lina Alatta: /* Pathophysiology */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==

==Pathophysiology==

*The pathophysiology is similar to that seen in [[angina pectoris]] and [[intermittent claudication]].
*Abdominal angina occurs due to narrowing of the mesenteric vessels that causes decreased blood flow.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*The most common cause of abdominal angina is an atherosclerotic vascular disease at ostia of the mesenteric vessels. Superior mesenteric artery occlusion is often found in patients presenting symptomatic occlusive mesenteric ischemia. Patients with abdominal angina are unable to increase flow in the mesenteric vessels in response to eating that's why they develop postprandial pain.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

It can be associated with:

*[[carcinoid]]<ref name="pmid16086212">{{cite journal |author=deVries H, Wijffels RT, Willemse PH, ''et al'' |title=Abdominal angina in patients with a midgut carcinoid, a sign of severe pathology |journal=World journal of surgery |volume=29 |issue=9 |pages=1139–42 |year=2005 |pmid=16086212 |doi=10.1007/s00268-005-7825-x}}</ref>
** [[Carinoid]] tumors can synthesis different types of amine and peptides, like serotonin, 5-hydroxytryptophan, ACTH, substance P, motilin, met-enkephalin, P-endorphin, neurotensin, gastrin, and somatostatin, but the agent which responsible for mesenteric vascular ischemia. Many of these substances have action on smooth muscles like substance P, motilin, and neurotensin which might have a role in the development of vascular elastosis.<ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>
** Midgut carcinoids are known to be more endocrinologically active than those arising from the hindgut, which may be the cause of the fact that elastic vascular sclerosis has not been found in the latter <ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>

*[[aortic coarctation]]<ref name="pmid14627320">{{cite journal |author=Ingu A, Morikawa M, Fuse S, Abe T |title=Acute occlusion of a simple aortic coarctation presenting as abdominal angina |journal=Pediatric cardiology |volume=24 |issue=5 |pages=488–9 |year=2003 |pmid=14627320 |doi=10.1007/s00246-002-0381-3}}</ref>

*[[antiphospholipid syndrome]]<ref name="pmid12111088">{{cite journal |author=Choi BG, Jeon HS, Lee SO, Yoo WH, Lee ST, Ahn DS |title=Primary antiphospholipid syndrome presenting with abdominal angina and splenic infarction |journal=Rheumatol. Int. |volume=22 |issue=3 |pages=119–21 |year=2002 |pmid=12111088 |doi=10.1007/s00296-002-0196-9}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina pathophysiology

2021-07-15T23:19:28Z

Lina Alatta: /* Pathophysiology */

__NOTOC__
{{Abdominal angina}}
{{CMG}}

==Overview==

==Pathophysiology==

*The pathophysiology is similar to that seen in [[angina pectoris]] and [[intermittent claudication]].
*Abdominal angina occurs due to narrowing of the mesenteric vessels that causes decreased blood flow.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
*The most common cause of abdominal angina is an atherosclerotic vascular disease at ostia of the mesenteric vessels. Superior mesenteric artery occlusion is often found in patients presenting symptomatic occlusive mesenteric ischemia. Patients with abdominal angina are unable to increase flow in the mesenteric vessels in response to eating that's why they develop postprandial pain.<ref name="urlAbdominal Angina - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK441943/ |title=Abdominal Angina - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>

It can be associated with:

*[[carcinoid]]<ref name="pmid16086212">{{cite journal |author=deVries H, Wijffels RT, Willemse PH, ''et al'' |title=Abdominal angina in patients with a midgut carcinoid, a sign of severe pathology |journal=World journal of surgery |volume=29 |issue=9 |pages=1139–42 |year=2005 |pmid=16086212 |doi=10.1007/s00268-005-7825-x}}</ref>
** [{Carinoid]] tumors can synthesis different types of amine and peptides, like serotonin, 5-hydroxytryptophan, ACTH, substance P, motilin, met-enkephalin, P-endorphin, neurotensin, gastrin, and somatostatin, but the agent which responsible for mesenteric vascular ischemia. Many of these substances have action on smooth muscles like substance P, motilin, and neurotensin which might have a role in the development of vascular elastosis.<ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>
** Midgut carcinoids are known to be more endocrinologically active than those arising from the hindgut, which may be the cause of the fact that elastic vascular sclerosis has not been found in the latter <ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434212/pdf/gut00218-0151.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>

*[[aortic coarctation]]<ref name="pmid14627320">{{cite journal |author=Ingu A, Morikawa M, Fuse S, Abe T |title=Acute occlusion of a simple aortic coarctation presenting as abdominal angina |journal=Pediatric cardiology |volume=24 |issue=5 |pages=488–9 |year=2003 |pmid=14627320 |doi=10.1007/s00246-002-0381-3}}</ref>

*[[antiphospholipid syndrome]]<ref name="pmid12111088">{{cite journal |author=Choi BG, Jeon HS, Lee SO, Yoo WH, Lee ST, Ahn DS |title=Primary antiphospholipid syndrome presenting with abdominal angina and splenic infarction |journal=Rheumatol. Int. |volume=22 |issue=3 |pages=119–21 |year=2002 |pmid=12111088 |doi=10.1007/s00296-002-0196-9}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]

Abdominal angina pathophysiology

2021-07-15T22:33:02Z

Lina Alatta: /* Pathophysiology */

Urinary incontinence diagnostic study of choice

2021-07-04T20:11:28Z

Lina Alatta: /* Name of Diagnostic Criteria */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}; {{AE}}
==Overview==

==Diagnostic Study of Choice==

===Study of choice===

There is no single diagnostic study of choice for the diagnosis of [[Urinary incontinence]], but [[stress incontinence]] can be diagnosed based on [[stress test]] and [[urodynamics]].<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

====The comparison of various diagnostic studies for [disease name]====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |stress test
| style="background: #DCDCDC; padding: 5px; text-align: center;" |83% <ref name="urlA Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/29175541/ |title=A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%<ref name="urlA Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed2">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/29175541/ |title=A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed |format= |work= |accessdate=}}</ref>
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |one-hour pad test + stress test
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90% <ref name="urlSensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/18758212/ |title=Sensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |65% <ref name="urlSensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed2">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/18758212/ |title=Sensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed |format= |work= |accessdate=}}</ref>
|}
 [[stress test]] is the preferred investigation based on the sensitivity and specificity

=====Diagnostic results=====
The following finding on performing [[stress test]] is confirmatory for [[ stress incontinence]]:

*Urine leaks with the onset of the cough and stops when the cough is stopped.<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

=====Sequence of Diagnostic Studies=====
The various investigations must be performed in the following order:
*[[Urinalysis]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Post-void residual volume assessment]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Voiding diaries]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Pad testing]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Pelvic floor imaging]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Urodynamic studies]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Name of Diagnostic Criteria===
There are no established criteria for the diagnosis of [[Urinary incontinence]].

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

Urinary incontinence diagnostic study of choice

2021-07-04T20:10:40Z

Lina Alatta: /* Sequence of Diagnostic Studies */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}; {{AE}}
==Overview==

==Diagnostic Study of Choice==

===Study of choice===

There is no single diagnostic study of choice for the diagnosis of [[Urinary incontinence]], but [[stress incontinence]] can be diagnosed based on [[stress test]] and [[urodynamics]].<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

====The comparison of various diagnostic studies for [disease name]====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |stress test
| style="background: #DCDCDC; padding: 5px; text-align: center;" |83% <ref name="urlA Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/29175541/ |title=A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%<ref name="urlA Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed2">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/29175541/ |title=A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed |format= |work= |accessdate=}}</ref>
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |one-hour pad test + stress test
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90% <ref name="urlSensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/18758212/ |title=Sensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |65% <ref name="urlSensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed2">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/18758212/ |title=Sensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed |format= |work= |accessdate=}}</ref>
|}
 [[stress test]] is the preferred investigation based on the sensitivity and specificity

=====Diagnostic results=====
The following finding on performing [[stress test]] is confirmatory for [[ stress incontinence]]:

*Urine leaks with the onset of the cough and stops when the cough is stopped.<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

=====Sequence of Diagnostic Studies=====
The various investigations must be performed in the following order:
*[[Urinalysis]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Post-void residual volume assessment]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Voiding diaries]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Pad testing]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Pelvic floor imaging]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Urodynamic studies]] <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Name of Diagnostic Criteria===
There are no established criteria for the diagnosis of [disease name].

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

Urinary incontinence diagnostic study of choice

2021-07-04T17:46:57Z

Lina Alatta: /* The comparison of various diagnostic studies for [disease name] */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}; {{AE}}
==Overview==

==Diagnostic Study of Choice==

===Study of choice===

There is no single diagnostic study of choice for the diagnosis of [[Urinary incontinence]], but [[stress incontinence]] can be diagnosed based on [[stress test]] and [[urodynamics]].<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

====The comparison of various diagnostic studies for [disease name]====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |stress test
| style="background: #DCDCDC; padding: 5px; text-align: center;" |83% <ref name="urlA Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/29175541/ |title=A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%<ref name="urlA Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed2">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/29175541/ |title=A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed |format= |work= |accessdate=}}</ref>
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |one-hour pad test + stress test
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90% <ref name="urlSensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/18758212/ |title=Sensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |65% <ref name="urlSensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed2">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/18758212/ |title=Sensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed |format= |work= |accessdate=}}</ref>
|}
 [[stress test]] is the preferred investigation based on the sensitivity and specificity

=====Diagnostic results=====
The following finding on performing [[stress test]] is confirmatory for [[ stress incontinence]]:

*Urine leaks with the onset of the cough and stops when the cough is stopped.<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

=====Sequence of Diagnostic Studies=====
The various investigations must be performed in the following order:

*[Initial investigation]
*[2nd investigation]

===Name of Diagnostic Criteria===
There are no established criteria for the diagnosis of [disease name].

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

Urinary incontinence diagnostic study of choice

2021-07-04T17:43:47Z

Lina Alatta: /* The comparison of various diagnostic studies for [disease name] */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}; {{AE}}
==Overview==

==Diagnostic Study of Choice==

===Study of choice===

There is no single diagnostic study of choice for the diagnosis of [[Urinary incontinence]], but [[stress incontinence]] can be diagnosed based on [[stress test]] and [[urodynamics]].<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

====The comparison of various diagnostic studies for [disease name]====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |stress test
| style="background: #DCDCDC; padding: 5px; text-align: center;" |83% <ref name="urlA Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/29175541/ |title=A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%<ref name="urlA Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed2">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/29175541/ |title=A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence - PubMed |format= |work= |accessdate=}}</ref>
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |one-hour pad test + stress test
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90% <ref name="urlSensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/18758212/ |title=Sensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |65% <ref name="urlSensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed2">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/18758212/ |title=Sensitivity and specificity of one-hour pad test as a predictive value for female urinary incontinence - PubMed |format= |work= |accessdate=}}</ref>
|}
 [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity

=====Diagnostic results=====
The following finding on performing [[stress test]] is confirmatory for [[ stress incontinence]]:

*Urine leaks with the onset of the cough and stops when the cough is stopped.<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

=====Sequence of Diagnostic Studies=====
The various investigations must be performed in the following order:

*[Initial investigation]
*[2nd investigation]

===Name of Diagnostic Criteria===
There are no established criteria for the diagnosis of [disease name].

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

Urinary incontinence diagnostic study of choice

2021-06-29T17:52:06Z

Lina Alatta: /* Name of Diagnostic Criteria */

Urinary incontinence diagnostic study of choice

2021-06-29T17:47:10Z

Lina Alatta: /* Study of choice */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}; {{AE}}
== Overview ==

== Diagnostic Study of Choice ==

=== Study of choice ===

There is no single diagnostic study of choice for the diagnosis of [[Urinary incontinence]], but [[stress incontinence]] can be diagnosed based on [[stress test]] and [[urodynamics]].<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
 [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity

===== Diagnostic results =====
The following finding on performing [[stress test]] is confirmatory for [[ stress incontinence]]:
* Urine leaks with the onset of the cough and stops when the cough is stopped.<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===== Sequence of Diagnostic Studies =====
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]

=== Name of Diagnostic Criteria ===

'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''

[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].

OR

There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].

OR

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3

OR

'''IF there are clear, established diagnostic criteria'''

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

'''IF there are no established diagnostic criteria'''

There are no established criteria for the diagnosis of [disease name].

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

Urinary incontinence diagnostic study of choice

2021-06-29T17:42:34Z

Lina Alatta: /* Study of choice */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}; {{AE}}
== Overview ==

== Diagnostic Study of Choice ==

=== Study of choice ===

There is no single diagnostic study of choice for the diagnosis of [Urinary incontinence], but [[stress incontinence]] can be diagnosed based on [[stress test]] and [[urodynamics]].<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
 [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity

===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]

===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.

OR

The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]

=== Name of Diagnostic Criteria ===

'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''

[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].

OR

There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].

OR

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3

OR

'''IF there are clear, established diagnostic criteria'''

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

'''IF there are no established diagnostic criteria'''

There are no established criteria for the diagnosis of [disease name].

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

Urinary incontinence other diagnostic studies

2021-06-03T02:42:48Z

Lina Alatta: /* Urodynamics */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Other Diagnostic Studies==
===Cystoscopy===
*[[Cystoscopy]] - Indicated in pateints with irriative bladder symtpoms such as urgency, frequency and hematuria, it's useful to rule out tumors, inflammmation and anatomical deformities.<ref name="urlUrinary incontinence">{{cite web |url=https://www.slideshare.net/DrJograjiyaGela/urinary-incontinence-42343087 |title=Urinary incontinence |format= |work= |accessdate=}}</ref>

===Urodynamics===
*[[Urodynamics]] - various techniques measure pressure in the bladder and the flow of urine.
**[[Uroflometry]] - measure urine flow rate over time.<ref name="urlUrodynamic study">{{cite web |url=https://www.slideshare.net/sumitgupta94617999/urodynamic-study |title=Urodynamic study |format= |work= |accessdate=}}</ref>
**[[Cytometry]]- measure intravesical bladder pressure during bladder filling.It asses bladder capacity , sensation , complaince and detusor activity <ref name="urlUrodynamic study">{{cite web |url=https://www.slideshare.net/sumitgupta94617999/urodynamic-study |title=Urodynamic study |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence other diagnostic studies

2021-06-03T02:21:57Z

Lina Alatta: /* Cystoscopy */

Urinary incontinence other imaging findings

2021-06-03T02:08:25Z

Lina Alatta: /* Overview */

__NOTOC__
{{Urinary incontinence}}

{{CMG}}; {{AE}}

==Overview==
[[Cystourethrography]] may be helpful in the diagnosis of [[Urinary incontinence]]. Findings on an [[Cystourethrography]] suggestive of [[Urinary incontinence]] include absence of the posterior urethrovesical angle on the lateral veiw during straining and funneling of the bladder neck in the anterior posterior veiw.<ref name="urlUrinary incontinence">{{cite web |url=https://www.slideshare.net/DrJograjiyaGela/urinary-incontinence-42343087 |title=Urinary incontinence |format= |work= |accessdate=}}</ref>

==Other Imaging Findings==
*There are no other imaging findings associated with [[Urinary incontinence]].

==References==
{{Reflist|2}}

Urinary incontinence other imaging findings

2021-06-03T02:08:03Z

Lina Alatta: /* Other Imaging Findings */

__NOTOC__
{{Urinary incontinence}}

{{CMG}}; {{AE}}

==Overview==
[[Cystourethrography]] may be helpful in the diagnosis of [[Urinary incontinence]]. Findings on an [[Cystourethrography]]suggestive of [[Urinary incontinence]] include absence of the posterior urethrovesical angle on the lateral veiw during straining and funneling of the bladder neck in the anterior posterior veiw.<ref name="urlUrinary incontinence">{{cite web |url=https://www.slideshare.net/DrJograjiyaGela/urinary-incontinence-42343087 |title=Urinary incontinence |format= |work= |accessdate=}}</ref>

==Other Imaging Findings==
*There are no other imaging findings associated with [[Urinary incontinence]].

==References==
{{Reflist|2}}

Urinary incontinence other imaging findings

2021-06-03T02:04:40Z

Lina Alatta: /* Overview */

__NOTOC__
{{Urinary incontinence}}

{{CMG}}; {{AE}}

==Overview==
[[Cystourethrography]] may be helpful in the diagnosis of [[Urinary incontinence]]. Findings on an [[Cystourethrography]]suggestive of [[Urinary incontinence]] include absence of the posterior urethrovesical angle on the lateral veiw during straining and funneling of the bladder neck in the anterior posterior veiw.<ref name="urlUrinary incontinence">{{cite web |url=https://www.slideshare.net/DrJograjiyaGela/urinary-incontinence-42343087 |title=Urinary incontinence |format= |work= |accessdate=}}</ref>

==Other Imaging Findings==
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include:
*[Finding 1]
*[Finding 2]
*[Finding 3]

==References==
{{Reflist|2}}

Urinary incontinence other imaging findings

2021-06-03T01:58:42Z

Lina Alatta: /* Overview */

__NOTOC__
{{Urinary incontinence}}

{{CMG}}; {{AE}}

==Overview==
[[Cystourethrography]] may be helpful in the diagnosis of [[Urinary incontinence]]. Findings on an [[Cystourethrography]]suggestive of [[Urinary incontinence]]include absence of the posterior urethrovesical angle on the lateral veiw during straining and funneling of the bladder neck in the anterior posterior veiw.<ref name="urlUrinary incontinence">{{cite web |url=https://www.slideshare.net/DrJograjiyaGela/urinary-incontinence-42343087 |title=Urinary incontinence |format= |work= |accessdate=}}</ref>

==Other Imaging Findings==
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include:
*[Finding 1]
*[Finding 2]
*[Finding 3]

==References==
{{Reflist|2}}

Urinary incontinence other imaging findings

2021-06-03T01:46:17Z

Lina Alatta: /* Overview */

__NOTOC__
{{Urinary incontinence}}

{{CMG}}; {{AE}}

==Overview==
[Cystourethrography] may be helpful in the diagnosis of [Urinary incontinence]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

==Other Imaging Findings==
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include:
*[Finding 1]
*[Finding 2]
*[Finding 3]

==References==
{{Reflist|2}}

Urinary incontinence physical examination

2021-06-03T00:58:56Z

Lina Alatta: /* Vital Signs */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>
*Assses the patient cognitive status, mobility and presence of edma<ref name="urlUrinaryincontinence final">{{cite web |url=https://www.slideshare.net/nishanthps88/urinaryincontinence-final-78235043 |title=Urinaryincontinence final |format= |work= |accessdate=}}</ref>

===Vital Signs===
*Patient with urinary incontinence usually has normal vital signs.

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
**Q-tip test/cotton swab test:This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
[[File:Q-tip-test-urethral-hypermobility.jpg|400px|thumb|center]]<ref name="urlUrethral hypermobility causes, symptoms, diagnosis, treatment & prognosis">{{cite web |url=https://healthjade.net/urethral-hypermobility/ |title=Urethral hypermobility causes, symptoms, diagnosis, treatment & prognosis |format= |work= |accessdate=}}</ref>

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence physical examination

2021-06-03T00:28:09Z

Lina Alatta: /* Appearance of the Patient */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>
*Assses the patient cognitive status, mobility and presence of edma<ref name="urlUrinaryincontinence final">{{cite web |url=https://www.slideshare.net/nishanthps88/urinaryincontinence-final-78235043 |title=Urinaryincontinence final |format= |work= |accessdate=}}</ref>

===Vital Signs===

*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
**Q-tip test/cotton swab test:This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
[[File:Q-tip-test-urethral-hypermobility.jpg|400px|thumb|center]]<ref name="urlUrethral hypermobility causes, symptoms, diagnosis, treatment & prognosis">{{cite web |url=https://healthjade.net/urethral-hypermobility/ |title=Urethral hypermobility causes, symptoms, diagnosis, treatment & prognosis |format= |work= |accessdate=}}</ref>

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence physical examination

2021-06-03T00:27:14Z

Lina Alatta: /* Appearance of the Patient */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>
*Assses the patient cognitive status, mobility and perensce of edma<ref name="urlUrinaryincontinence final">{{cite web |url=https://www.slideshare.net/nishanthps88/urinaryincontinence-final-78235043 |title=Urinaryincontinence final |format= |work= |accessdate=}}</ref>

===Vital Signs===

*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
**Q-tip test/cotton swab test:This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
[[File:Q-tip-test-urethral-hypermobility.jpg|400px|thumb|center]]<ref name="urlUrethral hypermobility causes, symptoms, diagnosis, treatment & prognosis">{{cite web |url=https://healthjade.net/urethral-hypermobility/ |title=Urethral hypermobility causes, symptoms, diagnosis, treatment & prognosis |format= |work= |accessdate=}}</ref>

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence physical examination

2021-06-03T00:16:04Z

Lina Alatta: /* Genitourinary */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>

===Vital Signs===

*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
**Q-tip test/cotton swab test:This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
[[File:Q-tip-test-urethral-hypermobility.jpg|400px|thumb|center]]<ref name="urlUrethral hypermobility causes, symptoms, diagnosis, treatment & prognosis">{{cite web |url=https://healthjade.net/urethral-hypermobility/ |title=Urethral hypermobility causes, symptoms, diagnosis, treatment & prognosis |format= |work= |accessdate=}}</ref>

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence physical examination

2021-06-03T00:13:04Z

Lina Alatta: /* Genitourinary */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>

===Vital Signs===

*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
**Q-tip test/cotton swab test:This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
[[File:Q-tip-test-urethral-hypermobility.jpg|400px|thumb|center]]

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence physical examination

2021-06-03T00:10:41Z

Lina Alatta: /* Genitourinary */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>

===Vital Signs===

*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
[[File:Q-tip-test-urethral-hypermobility.jpg|400px|thumb|center]]**Q-tip test/cotton swab test:This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence physical examination

2021-06-03T00:09:20Z

Lina Alatta: /* Genitourinary */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>

===Vital Signs===

*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
**Q-tip test/cotton swab test: [[File:Q-tip-test-urethral-hypermobility.jpg|400px|thumb|left]]This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence physical examination

2021-06-03T00:08:25Z

Lina Alatta: /* Genitourinary */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>

===Vital Signs===

*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
**Q-tip test/cotton swab test: This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.[[File:Q-tip-test-urethral-hypermobility.jpg|400px|thumb|left]]

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence physical examination

2021-06-03T00:07:30Z

Lina Alatta: /* Genitourinary */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>

===Vital Signs===

*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
**Q-tip test/cotton swab test: This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
[[File:Q-tip-test-urethral-hypermobility.jpg|400px|thumb|left]]

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
{{Reflist|2}}
{{WH}}
{{WS}}

[[Category:Needs content]]
[[Category:Urology]]

Urinary incontinence physical examination

2021-06-03T00:06:11Z

Lina Alatta: /* Genitourinary */

__NOTOC__
{{Urinary incontinence}}
{{CMG}}

==Overview==
The [[physical examination]] will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.<ref name="pmid32644521">{{cite journal |vauthors=Tran LN, Puckett Y |title= |journal= |volume= |issue= |pages= |date= |pmid=32644521 |doi= |url=}}</ref>

==Physical examination==

===Appearance of the Patient===

*Patients with Urinary Incontinence usually appear obese (check BMI)<ref name="urlIncontinence & Female Urology [Dr.Edmond Wong]">{{cite web |url=https://www.slideshare.net/edwong56/incontinence-female-edmond |title=Incontinence & Female Urology [Dr.Edmond Wong] |format= |work= |accessdate=}}</ref>

===Vital Signs===

*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]

===Skin===

*Skin examination of patients with [[Urinary incontinence]] can show rashes,infections, sores and ulcers <ref name="urlWoman Health-Incontinence&Pelvic Organ Prolapse">{{cite web |url=https://www.slideshare.net/rahilanajihah/woman-healthincontinencepelvic-organ-prolapse?qid=b9cb6ef7-b21a-42d5-9e73-29d4a6d740d9&v=&b=&from_search=1 |title=Woman Health-Incontinence&Pelvic Organ Prolapse |format= |work= |accessdate=}}</ref>.

===HEENT===

*HEENT examination of patients with [[Urinary incontinence]] is usually normal.

===Neck===

*Neck examination of patients with [[Urinary incontinence]] is usually normal.

===Lungs===

*Examine for [[chronic obstructive pulmonary disease]] or [[bronchitis]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Heart===

*Check for signs of volume overload or [[congestive heart failure]] for example, rales and [[pedal edema]]<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>

===Abdomen===

*Check for a palpable abdominal massess and for a palpable bladder <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Check for signs indictive for [[collagen disorder]] like presence of striae.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Back===

*Palpate vertebra from up to down, (from the neck to coccyx) and check for any abnormalities that may be a cause for [[urinary incontinence]].<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*Check for costovertebral angle tenderness.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>

===Genitourinary===

*Genitourinary examination of patients with urinary incontinence:
*The urogenital examination might reveal [[vaginal atrophy]] and [[incontinence-associated dermatitis]] (that is, damage to the skin with exposure to urine)<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
**[[Stress Test]]:
***If there's loss of urine while coughing or [[Valsalva maneuver]] indicates positive test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***The test is done when the patient is in a dorsal position. If urine loss is not visible switch to squatting position. If still not visible then in standing position asking her to keep her feet on the ground at shoulder distance, lift the saree/gown and looking for urine loss on the floor in between her feet or trickling down of urine through the thighs.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
**[[Bonney's test]]:
***If the stress test is positive , Do bonney's test.<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
***Place the patient in the dorsal position. Doctor should place the middle and index fingers in the anterior vaginal wall on either sides of the urethra and push upward and backward to restore the posterior urethra-vesical angle and stabilizing the urethra. After that, the patient is asked to cough and checked for urine loss.If there is no urine loss, then the test is positive (which indicates distortion of posterior urethra-vesical angle is the cause of stress urinary incontinence). However, this test has limited value in stress incontinence evaluation<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*Examine for [[pelvic organ prolapse]] during a [[Valsalva maneuver]] over≥6 seconds, staging of pelvic organ prolapse is described by [[Pelvic Organ Prolapse Quantification (POP-Q)]]but a [[simplified description (S-POP-Q)]] has also been validated for use in clinical practice, which is a staging system that depends on assessment after emptying the bladder<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Simplified description (S-POP-Q)]] staging system only detects anatomical descent and does not detect the normal range, stage two descent is found in up to 50% of women, Only a weak-to-moderate correlation between anatomical descent and urinary symptoms has been described, common symptoms of prolapse is a vaginal bulge, sensation of heaviness or difficulty in voiding<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Women with stage 2-4 pelvic organ prolapse may have anatomical distortion that may kink the urethra, which can cause a false-negative cough stress test. Thus, reducing the prolapse digitally without distorting the bladder neck while performing a cough stress test might be of value. However, limited evidence has been reported on how to optimally reduce urethral kinking for the test<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Digital examination]] for pelvic floor muscle tone<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*Levator ani muscle strength assessment (digital palpation)
**Place the fingers on the posterior vagina at least 2–4 cm above the hymenal ring while the patient is in the dorsal position. Palpate both sides of the levator ani muscle to assess its resting tone, bulk, and spasticity. Afterthat, ask the pateint to contract the pelvic floor muscles maximally as long as possible. Rectus abdominis, adductors of the thigh, and gluteus muscles are not supposed to be contracted<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Now, levator ani is evaluated regarding muscle contraction (present/absent), strength and duration of contraction, and the ability to elevate the P/V fingers<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>. Grading is done according to the modified Oxford Scale
{| class="wikitable sortable"
|+Levator ani muscle strength assessment (Modified Oxford Scale)<ref name="urlApproach to a woman with urinary incontinence2">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
!Score
!Levator ani strength
|-
!0/5
!No contraction
|-
!1/5
!Flicker, barely perceptible
|-
!2/5
!Loose hold, (1-2 seconds)
|-
|3/5
|Firmer hold, (1-2 seconds)
|-
|4/5
|Good squeeze, 3-4 s, pulls fingers in and up loosely
|-
|5/5
|Stronger squeeze, 3-4 s, pulls finger in and up snugly
|}

*Abnormalities such as [[urethral diverticula]] and pelvic masses can also be detected while assessing for pelvic organ prolapse.<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>
*[[Speculum examination]] can help in assessing each vaginal compartment and in assessing for any extra-urethral loss of urine that may suggest a fistula<ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Rectal examination]] should be done if there's bowel dysfunction or neurological symptoms to asses for tone and sphincter squeeze, bowel dysfunction should prompt a general neurological examination, including testing of the S2-S4 nerve distribution <ref name="urlUrinary incontinence in women">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/ |title=Urinary incontinence in women |format= |work= |accessdate=}}</ref>.
*[[Urethral hypermobility test]]:
**Inspection: Inspect the patient during coughing or doing [[Valsalva maneuver]]. If there is urethral hypermobility, then the anterior vaginal wall will rotate outward, and external urethral meatus will rotate upward toward the ceiling <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
**Q-tip test/cotton swab test: This test is done in dorsal/dorsal lithotomy position. A sterile lubricated cotton-tipped swab is introduced through the urethra to the bladder and withdrawn up to the level of urethrovesical junction. The position of the cotton swab in relation to the horizontal is observed – usually resting angle is 0° or nearer to 0°. Then, the patient is asked to cough or do Valsalva, and movement of the swab stick is observed. If the straining makes an angle of 30° or more, i.e., moving away from the horizontal, it is diagnosed with the hypermobile urethra. The mere presence of hypermobile urethra is not diagnostic of [[stress urinary incontinence]], but this test has prognostic value if the operation is contemplated <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
[[File:Q-tip-test-urethral-hypermobility.jpg|200px|thumb]]

===Neuromuscular===

*Examine for signs of [[dementia]] and alerted mental status like [[delirium]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>.
*Examine for [[normal pressure hydrocephalus]] and [[Cerebral vascular accident]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Examine for [[Spinal stenosis]] <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>:
**[[cervical stenosis]] can cause damage to detrusor [[upper motor neurons]].
**[[lumbar stenosis]] can cause [[areflexia]].
*[[Sacral reflex]] – to check for [[pudendal nerve]] integrity. Two reflexes are tested:
*[[Anal reflex]] – Elicited by stroking the perianal skin lightly and observing for anal sphincter contraction. If the contraction is not observed, then feel it by palpation of the sphincter<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>
*[[Bulbocavernosus reflex]] – Elicited by tapping or squeezing the clitoris lightly and observing for contraction of the bulbocavernosus muscle and/or external anal sphincter <ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.
*The absence of one or both sacral reflexes signifies lower motor neuron lesion, usually resulting from trauma during delivery<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>.

===Extremities===

*Examine joints for signs of [[arthritis]] and mobility restricion <ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Peripheral [[edema]] of lower extremities<ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref>
*Asses mobility of joints, hypermobile joint can be indictive for collagen disorder<ref name="urlApproach to a woman with urinary incontinence">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978964/ |title=Approach to a woman with urinary incontinence |format= |work= |accessdate=}}</ref>

==References==
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[[Category:Needs content]]
[[Category:Urology]]

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2021-06-03T00:04:01Z

Lina Alatta: