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.
History of Symptoms
- 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.
- 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.
- 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.
- 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.
- 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.
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Practice Contact Phone Numbers: St Vincent’s Clinic 02 8382 6983; Mater Clinic 02 9950 4610