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Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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The initial exams and tests for all urinary problems after menopause are essentially the same. The doctor first asks about symptoms, medical and surgical history, medications, and habits, such as smoking, drinking caffeine, and exercising.

Women also undergo a physical exam. Depending on symptoms, the physical exam can include a vaginal, pelvic, and rectal exam.

For all conditions, but particularly for urinary tract infection, women are asked to provide a urine sample. Most often, women are asked to provide a "clean catch" sample, which means collecting the urine midstream after cleansing the area around the urethra. The following aspects of the urine are examined:

• Amount and appearance of the urine
• Chemistry of the urine, called a urinalysis, including tests to determine whether blood is present in the urine
• Microscopy of the urine to check for infection or abnormalities
• Culture of the urine (allowing a small amount of urine to sit in a sterile dish for a few days to check for bacteria growth)

Urinary tract infections

In most cases, a urinalysis provides the doctor with all the information needed to treat a urinary tract infection. In some cases, the urine is cultured to see what kind of bacteria is responsible for the infection. This information helps the doctor determine what type of antibiotic the infection will respond best to. If a more complicated infection is suspected, such as pyelonephritis or kidney failure, a woman may be asked to undergo blood tests. Severe urinary tract infections usually require intravenous (IV) antibiotics and possibly a hospital stay.

Bladder control problems

The number and type of tests women undergo depend on the type of bladder control problem and the severity.

• Postvoid residual measurements determine how well the bladder is emptied when a woman urinates. This is performed in two different ways. A catheter may be inserted into the bladder after a woman urinates to see if any urine remains or ultrasonography may be used to take a picture of the bladder to calculate how much urine remains in the bladder.
• Cotton swab tests check the urethra for hypermobility. Hypermobility occurs in many women with stress incontinence. As a woman lies on the exam table, the doctor inserts a well-lubricated, sterile, cotton-tipped applicator through the urethra into the bladder neck. Hypermotility is present of the swab moves excessively when the woman is asked to cough or bear down (these methods cause increasing pressure within the abdomen).
• Urodynamic tests check bladder and sphincter muscle strength and function and are often described as an ECG of the bladder. These tests are typically performed in a series and can determine if the bladder fills and empties normally. These tests can also show if the sensation of bladder fullness matches the bladder actually being full.
• Cystoscopy is an outpatient procedure that allows the doctor to see the inside of the bladder by inserting a thin tube into the urethra and up into the bladder. The pictures are viewed on a television screen.

Bladder prolapse

The primary way to diagnose bladder prolapse is through a physical exam of the female genitalia to see if the bladder has entered the vagina, which confirms the diagnosis. Other tests may be performed to determine the grade of bladder prolapse:

• Urodynamic tests check bladder and sphincter muscle strength and function. These tests are typically performed in a series and can determine if the bladder fills and empties normally. These tests can also show if the sensation of bladder fullness matches the bladder actually being full.
• Cystoscopy (described above) may be used to visualize the bladder surface.
• Voiding cystourethrogram provides the doctor with a view of how the urinary anatomy functions with a series of X-ray films taken while a woman urinates.
• X-ray films of other parts of the abdomen may be taken to rule out other causes of symptoms.

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