To identify any causes or conditions that may exacerbate urinary incontinence or overactive bladder:

• Perform dipstick analysis of the urine in all women presenting with urinary incontinence to test for active infection and glycosuria.
• If the woman has symptoms of a urinary tract infection (UTI) and dipstick analysis is positive for both leukocytes and nitrites, send a mid-stream urine sample (MSU) and offer an antibiotic whilst waiting for the culture result.
• If the woman has symptoms of a UTI and dipstick analysis is positive for either leukocytes or nitrites (but not both), send an MSU and consider offering an antibiotic whilst waiting for the culture result.
• If the woman has symptoms of a UTI and dipstick analysis is negative for both nitrites and leukocytes, depending on clinical symptoms, decide whether to send an MSU and whether to offer an antibiotic.
• If the woman has no symptoms of a UTI and dipstick analysis is positive for both leukocytes and nitrites, send an MSU and do not offer antibiotics without the result of the urine culture.
• If the woman has no symptoms of a UTI and dipstick analysis is negative for either leukocytes or nitrites or both, do not routinely send an MSU and do not offer antibiotics.
• Perform a vaginal examination.
• Test for weak pelvic musculature by asking the woman to squeeze the examining finger to assess the strength and endurance of muscle tone.
• Look for evidence of pelvic organ prolapse — central (vault), anterior (cystocele), or posterior (rectocele), and atrophic vaginitis.
• Look for a pelvic mass.
• Ask about previous investigations and treatment, urinary tract disorders, low spinal surgery, previous surgery for incontinence, prolapse or hysterectomy, ano-rectal problems, and obstetric history.
• Previous surgery for urinary incontinence or pelvic organ prolapse may interfere with the normal support mechanisms of the vagina and urethra.
• Consider whether medication (including over-the-counter medication, such as herbal diuretics) could be causing or exacerbating the incontinence.
• Consider other factors, such as:
• Obesity.
• Smoking.
• High fluid, alcohol, and caffeine intake.
• Constipation.
• Consider and look for neurological conditions (particularly if there is urgency and/or chronic urinary retention [overflow incontinence]).
• Consider and look for systemic disease, such as heart failure and diabetes mellitus (particularly if there is urgency incontinence and nocturia).
• In elderly women in particular, look for cognitive impairment and consider the effect of restricted mobility and dexterity.

In depth