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The diagnosis of urinary incontinence is made based on a medical history, a physical examination and some confirmatory special tests. The health professional has to identify the types and severity of the incontinence, as well as the possible underlying causes.
A careful history will often indicate the type of incontinence. The amount of protection (such as pads) needed will give some indication of the severity of the problem. The voiding pattern is noted, and direct questions are asked regarding other urinary tract symptoms such as frequency or dysuria. Any concurrent or previous medical, surgical or obstetric history is noted.
The bladder is examined to see if it is full or empty, and whether it is tender or not. A basic neurological examination is performed to rule out neurological causes for the incontinence. The underwear and pads are examined for evidence of wetness. The genital skin is inspected for evidence of urine-induced dermatitis. The urethra and vagina are examined next, usually with a speculum in place. The health professional specifically looks for atrophy of the tissues and for evidence of leaking with coughing. An assessment is made of the integrity of the bladder and urethral support.
A urine sample is tested for evidence of infection or underlying bladder pathology (stone, tumour, and so forth). If there is an underlying cause of bladder instability this should be diagnosed and treated first. In the absence of an underlying cause the diagnosis is confirmed by urodynamic testing – which tests the functionality of the bladder and the bladder outlet.
The suspected findings are that of a small capacity bladder or an unstable bladder that contracts involuntarily at low volumes.
A careful history will often indicate the type of incontinence. The amount of protection (such as pads) needed will give some indication of the severity of the problem. The voiding pattern is noted, and direct questions are asked regarding other urinary tract symptoms such as frequency or dysuria. Any concurrent or previous medical, surgical or obstetric history is noted.
The bladder is examined to see if it is full or empty, and whether it is tender or not. A basic neurological examination is performed to rule out neurological causes for the incontinence. The underwear and pads are examined for evidence of wetness. The genital skin is inspected for evidence of urine-induced dermatitis. The urethra and vagina are examined next, usually with a speculum in place. The health professional specifically looks for atrophy of the tissues and for evidence of leaking with coughing. An assessment is made of the integrity of the bladder and urethral support.
A urine sample is tested for evidence of infection or underlying bladder pathology (stone, tumour, and so forth). If there is an underlying cause of bladder instability this should be diagnosed and treated first. In the absence of an underlying cause the diagnosis is confirmed by urodynamic testing – which tests the functionality of the bladder and the bladder outlet.
The suspected findings are that of a small capacity bladder or an unstable bladder that contracts involuntarily at low volumes.
