History and Physical Exam
Diagnosis starts with a detailed medical history and physical exam performed by your provider. During this appointment, the provider evaluates your symptoms and tries to diagnosis the type of urinary incontinence. Your provider also conducts a detailed pelvic exam to evaluate your pelvic support, anatomy, and muscle strength. Be prepared to answer questions about risk factors for incontinence and other pelvic floor disorders, such as your:
- Pregnancy and childbirth history
- Bowel habits
- Medicines—both over-the-counter and prescriptions, as well nutrition supplements
- Sex life—any discomfort of pain you are experiencing during and after intercourse
Your provider may have you fill out a bladder diary to better understand how often and how much you urinate and what leads to urinary leakage.
The diary can help you track voiding behavior. Many urinary issues develop slowly, over time. You may not be aware of how often you void, or how often you revise usual activities because of fear of leakage—because the problem has been sneaking up on you for so long. Seeing this reality “in writing” can be useful for you and your provider.
At the beginning of treatment, bladder diaries are helpful in establishing the nature and severity of your bladder control problem. Also, because many times the benefits of treatment take a long time to become obvious, small changes in bladder diary information can help a woman’s provider know whether or not a set of treatments is working.
Depending on your symptoms and physical exam, your provider may want to do some additional bladder testing.
What is Urodynamic Testing?
Urodynamics test the functions and behaviors of the bladder and the urethra (the tube that leads from your bladder to the outside). This procedure usually involves the placement of a very small catheter, or tube, in the bladder, and another small tube in the vagina or the rectum. Sterile fluid is then used to fill the bladder, so that your doctor can tell how the bladder behaves as it is getting full.
Why is Urodynamic Testing Necessary?
This kind of testing can be very helpful to figure out what parts of your bladder and urethra are functioning correctly, and which parts are not. The reasons that a woman might be experiencing incontinence, urgency, or difficulty emptying her bladder can be very complex. Urodynamics help the doctor find out what might be going on. The often help your doctor determine the best treatment for you.
Are Urodynamic Tests Uncomfortable?
Urodynamic testing is not be painful; however, it may cause some discomfort. An anesthetic gel solution may be used, and the catheters are generally very small. As your bladder is filled with sterile fluid, you may feel as though you have the urge to urinate. These sensations are an important part of the test itself, so be sure to tell the staff what you are feeling. You may be asked to cough, bear down, or other maneuvers which might make you leak urine; do not worry about this. It is important to remember that these tests can often help you find the right treatment to fix these problems.
Some people have mild burning or irritation when they urinate after the test. This typically goes away within a day. Most women can resume their normal activities after testing.
What Prep is Required Before Testing?
Your doctor may request that you arrive at the office with a full bladder, if you can. In the days before the test, your doctor may also check for a urinary tract infection, which will require leaving a sample.
What is Cystoscopy?
Cystoscopy is a way to look at the inside of your bladder. Numbing gel maybe placed in the urethra, which is the tube between your bladder and the outside world. After this, your doctor passes a tiny telescope into the bladder. Next, so that the doctor can see inside, the doctor fills the bladder with sterile fluid. This allows your doctor to make sure that there are no abnormalities or other problems, which might be causing your bladder symptoms. The test generally takes between 10 and 30 minutes.
Why is Cystoscopy Necessary?
Cystocopy helps the doctor learn if the inside of the bladder or urethra has any problems, such as stones, tumors, inflammation, or other problems which might be contributing to the bladder not working properly.
Is Cystoscopy Uncomfortable?
The procedure should not be painful. The numbing gel helps to reduce any irritation. However some women experience a slight discomfort, but generally not pain. As your bladder is filling with water, you may feel the need to urinate. Some people have mild burning or irritation with urination after the test. This typically goes away within a day. You should be able to resume your normal activities after cystoscopy.
What Prep is Required Before Testing?
Generally, no preparation is required. Your doctor may also check for a urinary tract infection in the days before the test, which will require leaving a sample.