Bladder Control Problems (cont.)
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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.
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.
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.
George Lazarou, MD, FACOG
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In the practice of physical medicine and rehabilitation, voiding disorders are usually a result of neurologic conditions, such as spinal cord injury (SCI) or disease, cerebrovascular accident (CVA), traumatic brain injury (TBI), multiple sclerosis (MS), or dementia.