During your visit, your doctor looks for clues that may also indicate contributing factors. Your appointment will likely include a:
- Medical history
- Physical exam with particular focus on your abdomen and genitals
- Urine sample to test for infection, traces of blood or other abnormalities
- Brief neurological exam to identify any pelvic nerve problems
- Urinary stress test, in which the doctor observes urine loss when you cough or bear down
Tests of bladder function
Your doctor might order urodynamic tests, which are used to assess the function of your bladder. Testing isn't necessary in most cases of uncomplicated stress urinary incontinence.
Bladder function tests may include:
Measurements of post-void residual urine. If there's concern about your ability to empty your bladder completely, particularly if you are older, have had prior bladder surgery or have diabetes, a test of your bladder efficiency may be needed.
To measure residual urine after you have voided, a thin tube (catheter) is passed through the urethra and into your bladder. The catheter drains the remaining urine, which can then be measured. Or a specialist may use an ultrasound scan, which translates sound waves into an image of your bladder and its contents.
Measuring bladder pressures. Some people, particularly if they have had a neurologic disease of the spinal cord, will need cystometry. Cystometry measures pressure in your bladder and in the surrounding region during bladder filling.
A catheter is used to fill your bladder slowly with warm fluid. Tests of your bladder leakage will be done during the filling to check for stress incontinence. This procedure may be combined with a pressure-flow study, which tells how much pressure your bladder has to exert in order to empty completely.
- Creating images of the bladder as it functions. Video urodynamics uses imaging to create pictures of your bladder as it's filling and emptying. Warm fluid mixed with a dye that shows up on X-rays is gradually instilled in your bladder by a catheter while the images are recorded. When your bladder is full, the imaging continues as you urinate to empty your bladder.
- Cystoscopy. This is an examination of the bladder and urethra using a scope inserted into the bladder. This procedure is usually completed in the office.
You and your doctor should discuss the results of any tests and decide how they impact your treatment strategy.