History

A full history of the main symptoms is taken as well as other symptoms that may be present but are not recognised as important. There are five common groups of symptoms.

URINARY INCONTINENCE SYMPTOMS
IRRITATIVE BLADDER SYMPTOMS
PROLAPSE SYMPTOMS
VOIDING SYMPTOMS
RECURRENT URINARY TRACT INFECTIONS
Other past and present medical and surgical history will be sought including a list of any medications.

Most women presenting for assessment will have more than one symptom.

1. Incontinence Symptoms

Stress Incontinence: Involuntary loss of urine with coughing, running, jumping, sneezing and other exercise activities.
Urge incontinence: Involuntary loss of urine associated with a compelling desire to void which is difficult to defer (urgency).
Coital Incontinence: Involuntary loss of urine during intercourse. This is not uncommon.
Enuresis: Bed-wetting. This may be a continuation of childhood bed-wetting or a recurrence of this symptom later in life.

2. Irritative Symptoms

Frequency: More than 7 episodes of passing urine a day may be excessive. This comment depends on fluid intake to a degree.
Nocturia: Getting up to pass urine more than once per night is probably excessive. Excess fluids before bed may contribute.
Urgency: A compelling desire to void which is difficult to defer.

3. Prolapse Symptoms

Pelvic pressure: A dragging, heaviness feeling or fullness in the lower abdomen generally concentrated above the pubic bone.
Vaginal lump: If the prolapse is more advanced, women will feel a bulge or a lump sitting at the entrance to the vagina or even outside the vaginal entrance.
Sacral backache: A period-like sacral (lower) backache may indicate prolapse due to the stretching of the supports of the uterus and upper vagina (uterosacral ligaments) which are attached there.
Dyspareunia: Pain with intercourse. If there is say uterine prolapse, the lower part (the cervix) may be impinged upon with intercourse, causing discomfort.

4. Voiding Symptoms

Hesitancy: Difficulty with commencing to pass urine.
Poor stream: Noticeable slowing or interruption of the passage of urine over time.
Incomplete emptying: Following passing urine, the feeling that there is still more urine left.
Need to immediately re-void: A desire to pass urine a second time shortly after the first time.
Strain to void: The need to push or strain to achieve passage of urine.

5. Recurrent Urinary Tract Infections (UTI)

This means at least three confirmed infections in the last 12 months. Many women suffer more than this. There may be a relation to intercourse, long distance travel (dehydration) or prior surgery though quite often none of these relations exist.

Other Medical and Surgical History and Medications

Past surgery: Any operations for general gynaecological problems, especially hysterectomy, or past bladder surgery are generally most relevant
Past or present medical illnesses: It is important to understand any or all past and intercurrent illnesses as some of these might be relevant to management.
Menstrual / menopausal history: Bladder symptoms may co-exist with menstrual disorders. There may be a need to address both issues together. The average age for women presenting for assessment is 56 years. Often they are then post-menopausal and issues related to this might co-exist.
Medications: Research on those medications that might affect the bladder is relatively small. A complete list of medications is important in planning any treatment necessary. 

© Copyright Bernard T. Haylen 2017