Editing Functional: Urinary Incontinence (section)

=== History and Physical Exam ===
* '''History'''
** Characterize incontinence (subjectively, quantify leakage, duration of symptoms, any inciting events that contributed to the onset of leakage, impact on daily life and activities)
** Voiding pattern should be defined
** Treatment expectations and an understanding of the balance between benefits and risks/burden of available treatment options.
** '''Females'''
*** Regarding pelvic prolapse specifically, focus on whether the patient is aware of any prolapse and what, if any, symptomatology and bother the prolapse may be causing.
*** Gynecologic and obstetric history, including gravity, parity, and hormonal status.
*** Determination of whether the patient is premenopausal, perimenopausal, or post-menopausal and whether she has used any exogenous hormones such as oral contraceptives or local or systemic hormone replacement therapy
* '''Physical examination'''
** '''Body habitus (BMI)'''
** '''Females'''
*** '''External genitalia:''' general appearance, estrogen status, lesions, and labial size, and adhesions.
**** Attention to the overall tissue appearance and color is important. Hormonally deficient vaginal tissue has a pale, flat, dry appearance with no rugae, as opposed to the healthy, pink rugated tissue of well-estrogenized tissue
**** '''Findings that may indicate estrogen deficiency (3):''' 
****#'''Urethral caruncle'''
****#'''Urethral prolapse'''
****#'''Labial adhesions'''
*** '''Urethral position''' '''and mobility'''
**** '''Should be assessed at rest and with straining and coughing.'''
**** The Q-tip test was developed to objectify the evaluation of urethral mobility.
***** With the patient in the lithotomy position, a Q-tip is inserted into bladder through the urethra and the angle that the Q-tip moves from horizontal to its final position with straining is measured.
***** '''Hypermobility is defined as a Q-tip angle of > 30° from horizontal.'''
*** '''Assessment of prolapse'''
**** '''Ideally, should be performed in both the lithotomy and standing position'''.
** Anal sphincter tone
***A reflection of the function at S2-4
***Particularly important in neurologic patients with pelvic floor dysfunction