3- Physical Examination
The primary purpose of the physical examination is to exclude confounding or contributing factors to the incontinence or its management.
A urethral diverticulum (an out-pouching of the urethral lumen) can produce incontinence or postvoid dribbling. Occasionally, vaginal discharge can be confused with urinary incontinence. Extraurethral incontinence, caused by a fistula or ectopic ureter, is rare but can be seen on examination. A lack of such physical findings indicates the patient may have uncomplicated SUI. Evidence of pelvic organ prolapse (POP) beyond the hymen is consistent with complicated SUI because the prolapse can produce a relative obstruction of the urethra that can impair bladder emptying. Therefore, it is recommended that all pelvic support compartments (anterior, posterior, and apical) be assessed (7, 8). Pelvic organ prolapse can mask or reduce the severity of SUI symptoms; this is referred to as occult, potential, masked, or hidden SUI. When POP is reduced with a nonobstructing pessary or large cotton swabs, SUI may become apparent or worsen (9). If no POP is found beyond the hymen, then the patient’s SUI remains uncomplicated.