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Gold, incentives and meh

Three questions to diagnose urinary incontinence

Bitesize evidence

Q Can a questionnaire be used to differentiate between urge and stress incontinence?


The authors of this study tested a three-item questionnaire to see if it could accurately

differentiate urge incontinence and stress incontinence in women. They recruited through advertisements women who were at least 40 and had untreated incontinence (for an average of seven years) of a broad range of severity.

All 301 women in the study completed the written questionnaire and then were extensively evaluated by a urologist or urogynaecologist, who was unaware of the responses to the questions. The gold standard was blinded review of the extended evaluation by a second specialist, who was unaware of the questionnaire results or the conclusion of the first specialist.

Stress incontinence was diagnosed in 44 per cent of the patients, urge incontinence in 40 per cent, mixed in 14 per cent and other causes in 3 per cent. As compared with the gold standard, the questionnaire had a sensitivity of 0.75 and a specificity of 0.77 for urge incontinence, with a sensitivity of 0.86 and a specificity of 0.60 for stress incontinence. Given a similar distribution of types of incontinence, the questions will have a positive predictive value of 73 per cent for stress incontinence and 75 per cent for urge incontinence.

Level of evidence

2b (see


Brown JS et al, for the Diagnostic Aspects of Incontinence Study (Daisy) Research Group. The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence. Ann Intern Med 2006;144:715-723.

Bottom line

A simple three-item questionnaire – and one question in particular – can identify incontinence

as being either stress predominant or urge predominant in three out of four women. The written questionnaire is self-administered by the patient and takes about 30 seconds.


1. Have you leaked urine (even a small amount) in the last three months?

2. In the last three months, did you leak urine:

• when performing some physical activity such as coughing, sneezing, lifting or exercise?

• when you had the urge or feeling that you needed to empty your bladder?

• without physical activity or a sense of urgency?

3. During the last three months, did you leak urine most often:

• when you were performing some physical activity such as coughing, sneezing, lifting, or exercise? (diagnosis: stress)

• when you had the feeling that you needed to empty your bladder but you could not get to the toilet fast enough? (diagnosis: urge)

• without physical activity and without a sense of urgency? (diagnosis: other cause)

• about equally as often with physical activity as with a sense of urgency? (diagnosis: mixed)

Only question 3 was used to determine diagnosis

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