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Bladder Control Problems (cont.)

Diagnosis

Your health-care provider will ask questions about your symptoms and the situations in which you experience urine leakage. He or she will also ask you about your medical and surgical history, medications, and habits. A thorough physical exam will include your abdomen, pelvis (women), rectum (men), and nervous system.

You may be referred to a specialist. Physicians who specialize in diagnosing and treating disorders of the urinary tract include urogynecologists (for women) and urologists.

A physical exam should be performed. In women, a thorough vaginal and pelvic exam along with a rectal exam should be performed. The quality of the tissue, the degree of prolapse (bladder descent), and evaluation of masses or tissue support is documented.

In men, an exam of the genitalia with attention to the urethral meatus (opening) and a rectal exam are performed. The character and size of the prostate are evaluated.

Which tests are performed depends on which type(s) of incontinence your health-care provider suspects. A urine sample will be collected.

  • The amount and appearance of the urine will be recorded.
  • The chemistry of the urine will be analyzed (urinalysis).
  • The urine will be looked at under a microscope to check for infection and other abnormalities.
  • The urine will be cultured. A smear of urine is put in a small sterile dish and allowed to sit for a few days. If any bacteria grow on the dish, you probably have a urinary tract infection.

Postvoid residual measurement: This measures how well you are able to empty your bladder when you urinate. This is done for people whose symptoms suggest overflow incontinence. The measurement can be done in either of two ways.

  • You will first be asked to urinate normally. In men, a uroflow test is usually obtained to measure the velocity and character of the urinary stream. This can also be done in some women.
  • The first technique involves tapping your bladder after urination to see how much urine remains. The tap is done with a thin, soft plastic tube called a catheter. The catheter is inserted into your urethra and up into your bladder, and the urine flows out.
  • The second technique uses an ultrasound device to "take a picture" of the bladder. From this picture, the operator can calculate how much urine remains in the bladder.

Blood tests are not usually helpful, but your health-care provider may perform certain tests to rule out specific medical conditions.

A cotton swab test may be done. This evaluates the urethra for hypermobility. (Many women with stress incontinence have hypermobility.) A well-lubricated, sterile, cotton-tipped applicator is inserted through the urethra into the bladder neck. This is done in a lying-down position.

Urodynamic tests are used to discover how well the muscles of the bladder and sphincter are working. A series of these tests can measure your bladder capacity and how well your sensation reflects that. They can also tell whether your bladder fills and empties in a normal way. This test is often described as an "EKG of the bladder."

Cystoscopy is a technique that allows the doctor to view the inside of the bladder. A thin tube is inserted into your urethra and up into your bladder. This is a very important test for those people who have blood in their urine (hematuria) and for those with significant irritative voiding symptoms, especially in people who smoke.

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Read What Your Physician is Reading on Medscape

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