Background: Urinary incontinence is one of the most common medical complaints of women older than 50 years of age. Understanding the anatomy and physiology is important in the diagnosis and management of these patients.
Review summary: Evaluation of the incontinent patient is complicated by the frequent vagueness of the patient's complaints, complexity of anatomic pathways involved in maintaining continence, and the poor availability of specific diagnostic tests for evaluating incontinence. Close attention to specific aspects of the patient's history including type of leakage, precipitating factors, and associated symptoms can dramatically increase diagnostic yield. In addition to the routine neurologic examination, certain additional clinical testing sheds light on the site of lesion causing incontinence. Examination of tone and voluntary contraction of the anal sphincter, bulbocavernosus reflex, and the anal reflex are valuable but underused methods that can be cost-effective as a means of achieving a specific diagnosis. Electrophysiological testing may be needed as an adjunct to physical examination and includes electromyography of the anal sphincter and urodynamic testing.
Conclusions: Urinary incontinence is a problem that needs a systematic approach to the patient both in terms of specific questions and physical examination. This allows categorization of type of urinary incontinence and identification of the anatomic process. During treatment the underlying neurologic problem causing incontinence needs to be addressed. Mild incontinence may be treated by conservative measures that reduce social inconvenience. In patients for whom the problem is more severe, various pharmacologic and surgical options are available.