• Timothy L. Chase, MD, FACOG
• G. Daniel Robison IV, MD, FACOG
• Clarence L. Wilson II, MD, FACOG

• H. Kyle Rhodes, MD, FACOG
• Andrea C. Foiles, MD FACOG
• Rachel Z. Jones, MD FACOG

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Testing AND DIAGNOSING

The key to treating any medical issue is to fully understand the problem. Female urinary incontinence can be mild to severe, of several different types, and have various contributing factors. As a result, careful testing and individual attention are vital to making a correct diagnosis, which then determines the recommended course of treatment.

Steps we use when evaluating a patient

• We collect the patient’s history through questionnaires, voiding diaries (a record of when the urge occurs, when voiding and leakage occur, and the amount of leakage) and other methods.
• We perform a physical examination, including of the pelvic organs, concurrently assessing for prolapse.
• We often conduct a focused neurologic exam.
• The patient may be asked to do a standing stress test for urine leakage while coughing.
• We take measurements of the patient’s volume of voided urine and any post-void residual.

Diagnostic Tools for Urinary Incontinence

Urinalysis: A urinalysis is performed to determine if there is any evidence or early signs of disease (such as diabetes, kidney disease, urinary tract infections) or to detect blood in the urine.

Urine Culture: A culture is taken if there is anything found in the urinalysis that indicates infection. Infections should be treated before further testing is done.

Ultrasound: Imaging allows the physician to see the size and shape of kidneys, ureters and bladder. Ultrasound is also a quick way to determine how completely the bladder empties, or the amount of residual urine after voiding. If significant urine remains in the bladder after voiding, further testing, such as urodynamic testing, can help determine the cause—which may be either outlet obstruction or poor bladder contractility.

Cystoscopy: Physicians use imaging equipment (usually optic fibers on the end of a catheter) to see inside the bladder and urethra.

Urodynamic Testing: There are various tests that fall into this category and the ones chosen may vary depending on the patient’s symptoms and medical history. The purpose of urodynamic testing is to evaluate the bladder’s function and efficiency, taking measurements of the volume and rate at which the bladder empties.

Patients are asked to arrive with a full bladder and then urinate into a container. A very small catheter is inserted through the urethra into the bladder to measure the amount of volume remaining. The bladder may then be filled with water through the catheter until the patient feels the first urge to urinate and measurements are taken. Water is continually added while the patient resists urinating, until involuntary urination occurs. During this time, much important data is gathered.

Uroflowmetry— A noninvasive study frequently used to screen for bladder emptying problems, uroflowmetry measures the amount and rate of urine voided. Patients urinate into a special container and the urine flow over time is recorded.

Cystometry— The primary test used to reproduce and evaluate symptoms of incontinence and other bladder problems, this study evaluates how much your bladder can hold, how well the bladder muscles function and how the neurological signals work that tell you when your bladder is full. One or two catheters are used. Patients report any sensations they feel and they may be asked to cough, bear down or stand during the test.

Urethral Pressure Profile Study— Useful in determining the cause of incontinence, this is an evaluation of the amount of pressure in the urethra. A catheter is withdrawn slowly from bladder and special equipment generates a urethral pressure curve that physicians can then analyze.

Pressure Flow Study—This is an in-depth measurement of the pressure and flow of urine out of the bladder to evaluate problems with emptying urine. This study can be performed after cystometry using the catheters already in place.

Q-Tip Test: This simple, in-office procedure is used to help determine whether stress incontinence is caused by intrinsic sphincter deficiency (ISD). The patient is asked to lie flat on an examination table while a Q-Tip with Lidocaine Jelly is inserted into the urethra up to, but not through the urethral sphincter, approximately 2-3 centimeters. The patient then strains or coughs, and the angle of the Q-Tip’s movement is measured. The physician is able to determine the degree of hypermobility of the urethra during urination.

Pad Tests: The patient is given an oral medication that turns urine orange. Pads placed in the patient’s underwear are changed every six hours over a 24-hour period to determine the severity of the leakage problem.