If you are experiencing urinary incontinence, start by first seeing your family doctor or a general practitioner. In some cases you may be referred to a urologist,a urogynecologist or a nephrologist for help. A urologist is an expert in urine and bladder problems. A urogynecologist is an expert in women’s urine and bladder issues. Doctors who can diagnose and treat incontinence include:
Doctors’ appointments can be brief, so be well-prepared. Keep a diary that includes how often you urinate during the day, a record of the times and events surrounding leakage, and what you are drinking. This can help your doctor with diagnosis and treatment suggestions. Your doctor is also likely to ask you a number of questions such as:
Urinary diary — Sometimes, details about fluid intake and urine output are crucial to making the right diagnosis. Your doctor may give you a bladder diary and a measuring cup so that you can record the time and amount of any fluids you drink and the urine you void over a complete 24-hour period. You may be asked to repeat this 24-hour diary for three to five days. This allows the doctor to observe patterns important to diagnosis and treatment.
After completing a medical history, your doctor will also perform a physical exam, including a pelvic exam and urinalysis. If the problem is complex, additional tests may be performed later. Your doctor may also conduct some of the following evaluations:
Cough stress test — Doctors gradually add water to the bladder and ask you to cough or strain so that you leak urine.
Cytoscopy – During this procedure, doctors insert a slender camera via the urethra into the bladder so they can view the interior anatomy of the bladder and urethra.
Imaging tests — Imaging tests are used to identify upper or lower urinary tract structural abnormalities. Imaging tests that doctors use to diagnose incontinence include:
- Intravenous pyelogram (IVP) - During an IVP, doctors inject intravenous (IV) dye to the bloodstream and take X-rays of the entire urinary tract while the kidneys are processing the injected dye.
- CT scan – During a CT scan, an X-ray machine takes a rapid sequence of two-dimensional thin cross-sections of the abdomen and pelvis. This exam can be performed with or without contrast dye and provide great detail of most of the internal organs.
- Ultrasound – An ultrasound directs sound waves to bounce off the body's internal organs to produce an anatomic picture and is a screening tool for further tests.
Neurologic exam — A neurological exam is performed to evaluate the strength, sensation, and reflexes in your legs.
Pelvic exam — A pelvic exam is performed to assess pelvic relaxation or prolapse.
Pelvic floor assessment — A pelvic floor assessment may be performed to evaluate the strength of the pelvic floor muscles, and particularly, the ability to contract and relax the appropriate muscle group.
Urine tests — A urine assessment is a test that measures how much urine remains in the bladder within 15 minutes of voiding and is an estimation of the bladder's ability to efficiently "empty the tank." Urine samples can also be analyzed for other factors such as blood, sugar, crystals or signs of infection.
If the urinary condition is complex or previous therapies have been unsuccessful, your doctor may conduct additional tests. These studies evaluate the bladder and urethra by attempting to reproduce symptoms. Testing may include:
Cystometrogram — Catheters are placed in the bladder and vagina or rectum to reproduce daily urinary symptoms. During the test, doctors infuse fluid to evaluate parts of the bladder's function, including:
- any uncontrollable bladder contractions
- any urgency to urinate
- the pressure that develop within the bladder during the fluid storage process
- the volume at which the bladder cannot comfortably hold any more
- your perception of water filling the bladder
Pressure voiding study — A pressure voiding study is performed to identify abnormal voiding patterns or urine obstruction.
Stress testing — During stress testing, you may be asked to perform a number of maneuvers such as coughing, changing positions or bouncing on your heel with a catheter in place to reproduce any symptoms of urine leakage or incontinence.
Urethral pressure profile — During this test, a catheter placed in the urethra is manipulated to measure urethral function.
Uroflometry — During uroflometry, doctors use a tool to measure the varying rate of urine flow, as well as duration of urination while you urinate.
After a brief evaluation to determine the cause of incontinence, you can receive treatments that ease symptoms of overactive bladder and help you manage their impact on your daily life. In fact, there are more treatments for urinary incontinence today than ever before. Click here to learn more about treatment for incontinence here.
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