Onset and setting:
Precipitating events:
The frequency of occurrence:
Nocturia?:
Urgency?:
Severity:
Pad use?:
Effects on ADLs:
Patient denies: Hesitancy, slow stream, post micturition leakage, position-dependent micturition, and dysuria.
PMH: No medical or neurologic conditions like diabetes that can cause UI.
PSH: No urogynecological surgeries
Meds: All meds reviewed. No drugs that influence bladder or urethral function which can lead to UI. Agents that can affect lower urinary tract functions discussed, like: Diuretics, caffeine, alcohol, narcotic analgesics, anticholinergic drugs, antihistamines, psychotropic drugs, alpha-adrenergic blockers, alpha-adrenergic agonists, and CCBs.
Effects of symptoms on the quality of life:____
Patient denies red flags such as hematuria, obstructive symptoms, or recurrent urinary tract infections which may suggest referral to urologist or urogynecologist.
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Validated questionnaires for Urinary Incontinence
-Urogenital distress inventory (UDI)
-Incontinence Impact Questionnaire
-Questionnaire for Urinary Incontinence Diagnosis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891326/)
-Incontinence Quality of Life Questionnaire (I-QoL)
-Incontinence Severity Index (ISI)
-International Consultation on Incontinence Questionnaire (ICIQ)