Incontinence Diagnosis
There are numerous bladder problems and different types of incontinence. The doctor can determine what kind a patient has by taking a detailed medical history, reviewing the nature of their problem and ordering lab tests.
A urine test can screen for blood, protein, and other abnormalities. The doctor will perform a physical exam noting any aberrations. He or she may ask you to perform a cough stress test where you stand and cough to see if it provokes an accident. Another simple office test that can be performed is office cystometry which is demonstrated in the diagram below. A post-void residual urine test assesses how much you urinate and the amount left over after voiding. The test helps determine if there’s an obstruction in the urinary tract.
A post-void residual urine test assesses how much you urinate and the amount left over after voiding. There are two ways to do a post-void residual urine test:
- Catheter: A nurse slides a thin, flexible tube called a catheter through your urethra and into your bladder, then takes out the urine.
- Ultrasound: A machine uses sound waves to show live images of your bladder so your doctor can see how much urine is there.
Some researchers think catheters measure urine in the bladder better than an ultrasound, while others think the two tests work equally well. This test helps determine if there’s an obstruction in the urinary tract.
Voiding Diary
The physician may ask the patient to keep a voiding diary where they note how much liquid drunk, how much they urinate, and when and where they experience an accident. They will also note approximately how much urine they lose with each episode of incontinence and whether or not they experience a sense of urgency. This information will help the physician determine what kind of incontinence the patient has. A voiding diary can also help guide treatment decisions.
Specialized Tests to Diagnose Incontinence
Urology Specialists
Sometimes routine testing does not reveal the underlying cause, and further evaluation is required. The patient may be referred to a urologist or a urogynecologist for more specialized testing if their health concern is accompanied by pain, recurrent UTIs, blood or protein in the urine, neurological symptoms or muscle weakness, or pelvic organ prolapse. Women with this issue who have a history of radiation or surgery to the pelvic region may also be referred to a urologist who specialises in complicated female pelvic floor cases.
Urodynamic Testing
Specialized testing can assess how well the bladder, urethra, and sphincters store and dispose of urine. There are many different types of instruments that can be used for urodynamic testing. Cystometry is a test that is used to help diagnose urge incontinence. It measures bladder pressure. The structures in the pelvis can be visualized with ultrasound. Uroflowometry can measure the volume of urine and flow rate. This test is used to determine the strength of related muscles and helps assess whether urine flow is blocked. There are other tests a urologist may perform depending on the patients symptoms.
Urodynamic testing can be expensive and unpleasant for a patient to endure. Most urologists and urogynaecologists do simply in office testing to establish if the patient has stress urinary incontinence and only resort to urodynamic testing if the patient has a more complicated picture and the specialist finds it difficult to pinpoint the particular type of incontinence. Urodynamic testing may also be used if the patient has a history of previous bladder or pelvic floor surgery.