In many clinics, a basic evaluation consists of history, physical exam, urine culture and sensitivity, 24-hour urolog, quality-of-life questionnaires, cystoscopy, bladder neck ultrasound, cough stress test, postvoid residual, and multichannel urodynamics.

When obtaining history, besides in-depth questions about urinary complaints and pelvic support problems, patients are questioned in detail about obstructive defecation and fecal incontinence. In our clinic, 23% of patients with severe genuine stress incontinence or pelvic organ prolapse have fecal incontinence, which is in agreement with others (12-15). Many have obstructive defecation associated with rectal prolapse, rectocele, and intussusception (16,17). When there is a history of fecal incontinence or obstructive defecation, we include anal manometry, anal ultrasound, and pudendal nerve terminal motor latency studies to aid in the treatment plan. A basic filling cystometrogram with Valsalva leak point pressure is essential if multichannel urodynamic testing is not available.

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