Physical Examination

1. Immediately before the physical examination, the patient should void as normally and completely as possible. The voided volume should be recorded. A post-void residual volume can then be determined within 10 minutes by catheterization or ultrasound examination. Post-void residual volumes more than 100 mL are considered abnormal.

2. A clean urine sample can be sent for culture and urinalysis.

3. Determining post-void residual volume and urinalysis allows screening for overflow incontinence, chronic urinary tract infections, hematuria, diabetes, kidney disease and metabolic abnormalities.

4. The abdominal examination should rule out diastasis recti, masses, ascites and organomegaly. Pulmonary and cardiovascular assessment may be indicated to assess control of cough or the need for medications such as diuretics.

5. The lumbosacral nerve roots should be assessed by checking deep tendon reflexes, lower extremity strength, sharp/dull sensation and the bulbocavernosus and clitoral sacral reflexes.

6. The pelvic examination should include an evaluation for inflammation, infection and atrophy. Signs of inadequate estrogen levels are thinning and paleness of the vaginal epithelium, loss of rugae, disappearance of the labia minora and presence of a urethral caruncle.

7. A urethral diverticula is usually identified as a distal bulge under the urethra. Gentle massage of the area will frequently produce a purulent discharge from the urethral meatus.

8. Testing for stress incontinence is performed by asking the patient to cough vigorously while the examiner watches for leakage of urine.

9. While performing the bimanual examination, levator ani muscle function can be evaluated by asking the patient to tighten her "vaginal muscles" and hold the contraction as long as possible. It is normal for a woman to be able to hold such a contraction for five to 10 seconds. The bimanual examination should also include a rectal examination to assess anal sphincter tone, fecal impaction, occult blood, or rectal lesions.

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