Incontinence: Making The Diagnosis

You suspect you may be incontinent, but would like to know for sure. You also would like to know why and what to do to help deal with this embarrassing problem. There are several steps when making the diagnosis of "Urinary Incontinence".

You will be asked to keep a "voiding diary" either when you make the appointment call, or at your appointment. A voiding diary is simply a record that you will keep of every time you pass urine and the details concerning if it was voluntary or involuntary (leakage). You will record information like: if you were laughing or coughing at the time of the leakage, or if you were doing some kind of physical activity when you noticed the leakage. This will be important information to know when making the diagnosis.

Once at the appointment, you will be asked to fill out a incontinence questionnaire, another way your healthcare provider will have to gather clues about whether or not you are incontinent. The actual medical definition of incontinence is: The inability to restrain the natural discharge of urine or fecal matter.

At your appointment you will be asked to fill out a medical history that will include a listing of any current or recent medications, a history of pregnancies, surgeries and your illness history. If you are elderly you will also be asked to undergo a mental assessment examination. You will also be assessed for social and environmental factors that may influence your diagnosis.

The physical examination will include an evaluation of your abdomen, genitals, pelvis and rectum. You will be asked to cough and the healthcare provider will observe your urethra while you are coughing to see if there is any leakage of urine. If you leak urine while coughing that would indicate the diagnosis of stress incontinence. If the urine leakage occurs after the cough and is persistant than that would indicate a diagnosis of urge incontinence. The physical examination will give additional clues that your provider will use to determine the diagnosis. You will be asked for a urine specimen so that the laboratory can perform a urinalysis. This test will identify medical conditions that are associated with the following:

Bacteria present in the urine

Blood in the urine which may indicate kidney disease

Excess glucose in the urine (indicator of the disease - diabetes)

Protein present in the urine in excess of normal limits could indicate the presence of a blood disease, cardiac disease or kidney disease.

Pus in the urine, would mean that there is an infection

Your healthcare provider may also wish to conduct some specialized urine testing based on the findings of the urinalysis. These tests might be:

Postvoid residual volume (PRV)

Placing a catheter into your uretha and examining it by way of a pelvic ultrasound is how this test is conducted. It may be necessary to do several measurements.

Urodynamic Testing

An instrument called a "cystometer" may be used to measure the anatomic and function of your bladder and urethra. This test measures the pressure and capacity of the bladder.

Another specialized test may be performed when the urodynamic testing fails to duplicate the symptoms or when there are new symptoms like cystitis or when there is the presence of a disease such as menaturia or pyuria. This test is called a Cystoscopy and is used to identify the presence of lesions of the bladder or possible foreign bodies in the bladder.

You may also need to have imaging tests such as X-rays and ultrasound to evaluate physical conditions associated with incontinence. These images will be of the lower urinary tract that will be taken before, during, and after voiding urine. The bladder and the urethra will be examined using these images.


	Incontinence: Making The Diagnosis You suspect you may be incontinent, but would like to know for sure. You also would like to know why and what to do to help deal with this embarrassing problem. There are several steps when making the diagnosis of "Urinary Incontinence". You will be asked to keep a "voiding diary" either when you make the appointment call, or at your appointment. A voiding diary is simply a record that you will keep of every time you pass urine and the details concerning if it was voluntary or involuntary (leakage). You will record information like: if you were laughing or coughing at the time of the leakage, or if you were doing some kind of physical activity when you noticed the leakage. This will be important information to know when making the diagnosis. Once at the appointment, you will be asked to fill out a incontinence questionnaire, another way your healthcare provider will have to gather clues about whether or not you are incontinent. The actual medical definition of incontinence is: The inability to restrain the natural discharge of urine or fecal matter. At your appointment you will be asked to fill out a medical history that will include a listing of any current or recent medications, a history of pregnancies, surgeries and your illness history. If you are elderly you will also be asked to undergo a mental assessment examination. You will also be assessed for social and environmental factors that may influence your diagnosis. The physical examination will include an evaluation of your abdomen, genitals, pelvis and rectum. You will be asked to cough and the healthcare provider will observe your urethra while you are coughing to see if there is any leakage of urine. If you leak urine while coughing that would indicate the diagnosis of stress incontinence. If the urine leakage occurs after the cough and is persistant than that would indicate a diagnosis of urge incontinence. The physical examination will give additional clues that your provider will use to determine the diagnosis. You will be asked for a urine specimen so that the laboratory can perform a urinalysis. This test will identify medical conditions that are associated with the following: Bacteria present in the urine Blood in the urine which may indicate kidney disease Excess glucose in the urine (indicator of the disease - diabetes) Protein present in the urine in excess of normal limits could indicate the presence of a blood disease, cardiac disease or kidney disease. Pus in the urine, would mean that there is an infection Your healthcare provider may also wish to conduct some specialized urine testing based on the findings of the urinalysis. These tests might be: Postvoid residual volume (PRV) Placing a catheter into your uretha and examining it by way of a pelvic ultrasound is how this test is conducted. It may be necessary to do several measurements. Urodynamic Testing An instrument called a "cystometer" may be used to measure the anatomic and function of your bladder and urethra. This test measures the pressure and capacity of the bladder. Another specialized test may be performed when the urodynamic testing fails to duplicate the symptoms or when there are new symptoms like cystitis or when there is the presence of a disease such as menaturia or pyuria. This test is called a Cystoscopy and is used to identify the presence of lesions of the bladder or possible foreign bodies in the bladder. You may also need to have imaging tests such as X-rays and ultrasound to evaluate physical conditions associated with incontinence. These images will be of the lower urinary tract that will be taken before, during, and after voiding urine. The bladder and the urethra will be examined using these images. 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