Urinary incontinence can be a complicated diagnosis because the cause sometimes cannot be fully identified. Your doctor will first ask about your symptoms and medical history, and perform a physical exam. He or she will examine your urinary system and also your nervous system, which controls your bladder function. You will be asked how often you empty your bladder and under what circumstances leakage occurs. A physical exam will look for any physical causes such as blockages or nerve problems. You will be asked to keep a diary of your bladder habits. At some point you will most likely be referred to a urologist or a gynecologist for further evaluation and treatment.
Tests may include:
Because more than one cause can exist, each one must be systematically considered. Your doctor may order the following tests:
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Urine test
—This test will reveal signs of infection and how well the kidneys are functioning.
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Blood test
—Although not specific for most causes of urinary incontinence, blood tests reveal much about your general health and help select the most appropriate treatment options.
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Stress test
—You will be asked to bear down with a full bladder as your doctor watches for loss of urine. If you are a woman, the doctor will also be looking for the amount of bladder support. The most common cause of stress incontinence in women is relaxation of the floor of the bladder so that it bulges into the vagina when you strain. This bulging changes the angle of the sphincter in relation to the bladder and can cause leakage.
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Ultrasound
—An ultrasound device uses high-frequency sound waves to examine structures inside the body. For incontinence, this noninvasive tool assesses structures to determine the amount of urine left in the bladder after voiding.
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Cystoscopy
—A cystoscope is a thin tube with a light and a tiny telescope that is inserted into the urethra to view the urethra and bladder. Tumors, narrowing, and other abnormalities can easily be seen. At the same time, x-ray dye can be instilled for x-rays of the bladder and kidneys.
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X-rays
—Dye can be introduced into the urinary system either directly through the urethra or indirectly into a vein. Able to reveal many abnormalities, an x-ray taken after you pass the dye will reveal how much residual urine is in the bladder, a sign of obstruction or bladder weakness.
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Urodynamic test
—A variety of measurements can be made of your bladder function:
- Capacity
- Volume at which the bladder muscle reflexively contracts
- Pressures the bladder muscle generates
- Maximum pressure the sphincter can resist
- Speed of emptying
- Coordination between the sphincter muscle and the bladder muscle