Bladder Control

Stress Incontinence

Signs and Symptoms
Diagnosis
Treatment

Diagnosis

Incontinence is a common treatable condition. If you have a problem, make an appointment at the UCSF Women's Continence Center. Keep a diary that includes how often you urinate during the day, a record of the times and events surrounding leakage, and what you are drinking. This can help your health care provider make the proper diagnosis and decide on the appropriate treatment.

At your first visit, your UCSF Women's Continence Center provider will do a complete history and physical exam, including a pelvic exam and urinalysis. If your problem is complex, additional tests may be done at a later visit.

Depending on the particular details of your medical history, your doctor may proceed to any or all of the following physical evaluations.

• Neurologic examination to evaluate the strength, sensation, and reflexes in your legs.
• Pelvic examination to assess pelvic relaxation or prolapse.
• Postvoid residual urine assessment will measure how much urine remains in your bladder within 15 minutes of voiding. It offers an estimation of your bladder's ability to efficiently "empty the tank."
• Other assessments: At the same time a postvoid residual is checked, the same urine sample may be analyzed for other factors, such as blood, sugar, crystals or signs of infection. Such an evaluation can be accomplished with an office urine dipstick or the hospital laboratory's microscopic urinalysis.
• Urine culture: If a urine dipstick or urinalysis suggests signs of acute infection, a urine culture will be sent to the microbiology lab. In approximately 24 to 48 hours, bacterial growth can be detected and the specific strain identified.
• Pelvic floor assessment to evaluate the strength of your pelvic floor muscles, and particularly, your ability to contract and relax the appropriate muscle group.
• Cough stress test: Your doctor will instill water into your bladder, and then ask you to cough or strain in the same manner that would cause you to leak urine. This test can be performed in the office or incorporated into more elaborate urodynamics testing.
• URINARY DIARY: Sometimes details about your fluid intake and urine output are crucial to making the right diagnosis. Because this is not typically the sort of information we take notice of in our daily lives, your provider will give you a bladder diary and a measuring receptacle.

You may be asked to carefully record the time and amount of any fluids you drink and the urine you void over a complete 24-hour period. You may be asked to repeat this 24-hour diary for three to five days. This allows us to notice patterns that might be important to planning your treatment.

When the clinical picture seems less straightforward, or multiple previous therapies have been unsuccessful; your doctor may decide to pursue further diagnostic testing. The purpose of these studies is to evaluate the anatomic and functional status of the bladder and urethra, reproducing your symptoms. Testing may include:

• Cystometrogram: Catheters are placed in your bladder and vagina or rectum so that the physician can reproduce your daily urinary symptoms. During the test, fluid will be infused in a controlled fashion to determine various characteristics about your bladder's function, including:
  
  1. Your perception of water filling the bladder
  2. Any urgency to urinate
  3. Any uncontrollable bladder contractions
  4. The volume at which your bladder cannot comfortably hold any more
  5. The pressures that develop within your bladder during the fluid storage process
• Stress testing: You may be asked to perform a number of maneuvers such as coughing, changing positions, or bouncing on your heel with the catheter in place in an effort to reproduce any symptoms of urine leakage or incontinence.
• Urethral pressure profile: A catheter in your urethra is manipulated to measure urethral function.
• Uroflometry: During urination, a specially devised receptacle will measure the varying rate of urine flow, as well as duration of urination.
• Pressure voiding study to identify abnormal voiding patterns or urine obstruction

Other Tests

• Cytoscopy: A slender camera is inserted via the urethra into the bladder to enable your doctor to view the interior anatomy of the bladder and urethra. It is typically an outpatient diagnostic procedure performed for the following common symptoms:
  
  1. Blood or pus in urine with no bacteria present
  2. Bladder infections that are unusually difficult to treat
  3. New onset voiding irritation
  4. New onset bladder pain
  5. Suspected foreign body in the bladder
  6. Urodynamics tests fail to duplicate incontinence symptoms
• Radiologic tests identify upper or lower urinary tract structural abnormalities.
  
  1. Intravenous pyelogram (IVP) involves the administration of intravenous (IV) dye to your bloodstream to obtain X-ray snapshots of the entire urinary tract while the kidneys are processing the injected dye. This test cannot be performed if you have an allergic reaction to IV contrast dye, or abnormal kidney function
  2. CT scan of abdomen and pelvis in which an X-ray machine takes a rapid sequence of two-dimensional thin cross-sections of the body in the area of interest. This exam can be performed with or without contrast dye, depending on what your doctor is looking for. The X-rays provide great detail of most of the internal organs.
  3. Ultrasound doesn't involve X-rays. It uses a skin probe that directs sound waves to bounce off the body's internal organs to produce an anatomic picture. It can be a very useful screening tool.

Reviewed by health care specialists at UCSF Medical Center.
Last updated May 8, 2007