From the Guidelines
The best approach to evaluate and manage a patient with urinary incontinence and altered perineal sensation is to start with a comprehensive assessment using validated questionnaires to measure the level of symptoms and their impact on quality of life (QOL), as recommended by 1. This assessment should include a detailed history focusing on the onset, duration, and characteristics of incontinence, along with neurological symptoms. A thorough physical examination is also necessary, including a neurological assessment of perineal sensation, anal sphincter tone, and bulbocavernosus reflex. Some key points to consider in the evaluation process include:
- Ordering urinalysis to rule out infection
- Measuring post-void residual to assess bladder emptying
- Considering urodynamic studies to evaluate bladder function
- Using validated questionnaires, such as those discussed in 1, to assess the impact of incontinence on QOL For management, conservative measures should be initiated first, including:
- Pelvic floor exercises (Kegel exercises)
- Bladder training with timed voiding
- Lifestyle modifications such as fluid management and caffeine reduction Pharmacotherapy may be considered for specific types of incontinence, and neurological consultation is necessary if altered perineal sensation suggests underlying neurological conditions. Given the complexity of this condition, a multidisciplinary approach, incorporating urology, neurology, and physical therapy, may be necessary to adequately address both the urinary incontinence and altered perineal sensation, as implied by the need for comprehensive assessment and management strategies discussed in 1.
From the Research
Evaluation of Urinary Incontinence and Altered Perineal Sensation
To evaluate and manage a patient with urinary incontinence and altered perineal sensation, the following steps can be taken:
- A detailed history and physical examination are essential in diagnosing the underlying cause of urinary incontinence 2
- Urodynamic studies, including conventional urodynamic tests and extramural ambulatory urodynamic monitoring, can help diagnose detrusor instability and other micturition disorders 3
- The Q-tip cotton swab test can be used to assess urethral mobility and help diagnose genuine stress incontinence 2
- Perineal ultrasound scanning can be used as an alternative to radiologic urethrocystography to investigate female urinary incontinence 4
Diagnostic Tests
The following diagnostic tests can be used to evaluate urinary incontinence and altered perineal sensation:
- Urodynamic studies: to diagnose detrusor instability and other micturition disorders 3
- Q-tip cotton swab test: to assess urethral mobility and diagnose genuine stress incontinence 2
- Perineal ultrasound scanning: to investigate female urinary incontinence 4
- Physical examination: to assess for signs of neurogenic bladder dysfunction, such as spina bifida occulta 5
Management Options
The following management options can be considered for patients with urinary incontinence and altered perineal sensation:
- Duloxetine hydrochloride: a medication that can be used to treat stress urinary incontinence by increasing nerve stimulation to the urethral striated sphincter muscle 6
- Division of the filum terminale: a surgical procedure that can be used to treat neurogenic bladder dysfunction caused by a tethered cord 5
- Conservative management: including pelvic floor exercises and behavioral modifications, can be used to manage urinary incontinence and altered perineal sensation 3, 2