Neurologic Examination

Multiple sclerosis, Parkinson's disease, dementia, minor cerebrovascular accidents, and numerous additional neurologic processes can have genitourinary dysfunction as the presenting symptom. Back trauma and surgery, spinal stenosis, peripheral neuropathy, and damage to pelvic nerves also predispose women to incontinence and prolapse. Ambulation and mobility problems may jeopardize an individual's ability to reach a toilet, and should be identified. During the examination, the patient's mental status should be assessed. Cognitive impairment is a major impediment to behavioral modification and other forms of therapy. Realistic expectations regarding the ability to achieve continence in a demented patient should be addressed with family members and care providers.

Sensory and motor function of L1-S4 are of particular importance. Testing for light touch and pinprick over the perineum, inner and anterior thighs, and pretibial area will adequately test sensory function. The motor examination should include extension and flexion of the hip, knee, and ankle. The intact sacral reflexes are confirmed by checking

Table 3-1.1. Fecal incontinence scoring system

Sometimes

Usually

Type of

Rarely

<1/wk

<1/d

Always

Incontinence

Never

<1/mo

>1/mo

>1/wk

>1/d

Solid

0

1

2

3

4

Liquid

0

1

2

3

4

Gas

0

1

2

3

4

Wears pad

0

1

2

3

4

Lifestyle

0

1

2

3

4

alteration

the bulbocavernosus reflex and anal wink. The bulbocav-ernosus reflex is tested by stroking the labia or tapping the clitoris and looking for contraction of the bulbocavernosus and ischiocavernosus muscles. The anal wink is performed by stroking the perianal skin and noting contraction of the external anal sphincter. These tests should be performed bilaterally. Sacral reflexes can be difficult to evaluate and are often absent in neurologically intact women.

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