Female urinary incontinence is defined by the
International Society of Continence as an involuntary urine leak, demonstrated
objectively, which causes social and hygiene problems 1.
Many etiopathological factors have undoubtedly contributed to the difficulty in choosing
the best treatment for this problem. Factors considered as classic such as a high number
of pregnancies, poor assistance during labour, ageing, poor nutrition, and hygiene, have
been joined by venous and arterial periurethral irrigation from recent research. However,
scleroatrophic processes, from the mucosa or periurethral muscles, also contribute to
urinary incontinence; this may explain nullipara or post cesarean symptoms 2,3.
Symptoms suggesting bladder overactivity (frequency, urgency and nycturia) should be
carefully evaluated, since they can indicate potentially curable pathologies; for example
urinary tract infections and hypoestrogenemia can cause urge incontinence 4,5.
The increased complexity of exams used for diagnosing urinary incontinence demands a
careful evaluation of the risks and benefits for each patient.
Objective and quantitative evaluation of urinary incontinence are important both initially
and as a follow-up to treatment.
The examiner has to obtain a complete patient profile with a detailed description of the
urinary leak characteristics. Sudden occurrence is unusual and generally caused by
intravesical problems, such as infection, foreign bodies, tumor, or discarded calculus 5,6.
Smoking, obesity, constipation, and professions that demand the lifting and transportation
of weights, can give rise to a constant increase in intra abdominal pressure, compromising
pelvic floor quality 5.
Symptom frequency should provide a good indicator of urinary leak intensity and its effect
on patient quality of life. However, subjective frequency evaluation has not demonstrated
a precise relationship with incontinence gravity 7.
Stress urinary incontinence associated with frequency and urgency can cause social and
emotional problems 8.
Different authors (8,9,10,11,12) have tried to evaluate the psychosocial impact
of urinary incontinence by objective evaluation. NORTON (1982) noted that urinary leak
affects social activity and mental well-being 13.
WYMAN et al (1987) observed that urinary incontinence influences daily and social
activities, and self esteem, the last two being more affected, especially when involving
unfamiliar places, long trips, and physical activities 8. The reason for the difference is still not
very clear. Patients with urge incontinence are not capable of predicting urinary leak,
having less control than those with stress urinary incontinence 8.
PARKIN et al (1986) using the analogue visual scale in diagnosis observed that women with
urgency complaints are more aware of their symptoms than those with stress urinary
These authors also observed that after curing urge incontinence, the improvements could be
seen on the analogue visual scale.
Different tests have been used in the objective evaluation of urinary incontinence 14. However, these
tests use different principles, methodologies, and varying test periods; the accuracy and
reproducibility of these tests have been discussed. In 1983 the International Continence
Society promoted the 60-minute pad test for the evaluation of urinary incontinence14.
The aim of this study was to compare clinical subjective evaluation using questionnaire
and analogue visual scale, and objective evaluation using the 60-minute pad test in
diagnosing female urinary incontinence.