What initial assessments should I perform for a patient presenting with urinary incontinence?

Initial assessments for a patient presenting with urinary incontinence should include:

• History taking: Categorise the type of urinary incontinence (stress, urgency/overactive bladder, or mixed) based on symptoms and identify predisposing or precipitating factors and other diagnoses that may require referral or further investigation ¹.
• Physical examination: Perform a general physical exam including abdominal and external genitalia examination; consider vaginal or rectal examination if clinically indicated (e.g., to assess pelvic floor prolapse or anal tone) ¹,²,³.
• Pelvic floor muscle assessment: Undertake a digital assessment to confirm pelvic floor muscle contraction before starting supervised pelvic floor muscle training ¹.
• Urine testing: Perform a urine dipstick test to detect blood, glucose, protein, leucocytes, and nitrites. If infection is suspected, send a midstream urine sample for culture and sensitivity and start antibiotics if appropriate ¹,².
• Post-void residual volume measurement: Measure residual urine volume by bladder scan (preferred) or catheterisation if symptoms suggest voiding dysfunction or recurrent urinary tract infections ¹.
• Symptom and quality-of-life assessment: Use validated urinary incontinence-specific symptom and quality-of-life questionnaires to evaluate the impact and guide treatment ¹.
• Bladder diary: Encourage the patient to complete a bladder diary for at least 3 days to document urinary frequency, urgency, leakage episodes, fluid intake, and pad usage ¹,⁴,⁵.
• Medication review and assessment of contributing factors: Review medications and consider other causes such as neurological disease, diabetes, pelvic masses, or mobility and cognitive impairments ¹,³.

Additional notes: Do not routinely perform pad tests, cystoscopy, or imaging (other than bladder scan for residual urine) in the initial assessment ¹. Refer to specialist services if there are complex features such as persistent bladder pain, palpable bladder after voiding, neurological disease, or previous pelvic surgery ¹.