Testing for Female Incontinence
There are a number of tests which may be necessary to determine the exact cause of a woman’s incontinence. In most cases, however, the cause can be determined from a careful history and pelvic examination. The following information describes some of the tests that may be recommended and the purpose of each test.
History
Important information includes the length of time that incontinence has been present, if it is getting worse, if there is an urge to urinate before the leakage starts, if their is leakage with cough, laugh, sneeze, lifting, or during intercourse, if pads are necessary and how many, other urinary symptoms such as frequent urination, burning, or blood in the urine, the number of pregnancies and childbirths, and any other gynecological history.
Urinalysis
Examination of the urine can detect blood in the urine or urinary infection.
Pelvic Exam
Pelvic examination is the most important test to determineif stress incontinence is present. We pass a small catheter through the urethra and measure the volume of urine than remains after voiding to determine if a woman is emptying the bladder completely. We then fill the bladder to medium full so that the doctor can check for stress incontinence. The doctor will examine the lining of the vagina to look for vaginal atrophy and look for bulging of the bladder, rectum, or uterus into the vagina. The woman will be asked to cough or strain and the doctor will look for movement of the bladder and urethra and leakage of urine. If leakage is seen the bladder will be elevated by a finger placed gently against the bladder and the woman asked again to cough or strain. If bladder elevation prevents leakage then there is a very good chance that surgery can cure the incontinence.
Voiding diary
A voiding diary is used to determine the cause of frequent urination and to document the pattern of incontinence. A woman is asked to record the time and volume of each urination and to document episodes of incontinence.
This test is used to measure the forcefulness of the urinary stream in order to detect those women who have decreased bladder contraction and incomplete bladder emptying.
A urologist can look into the bladder with a telescope to look for any abnormalities which may cause incontinence. This is usually done if there is blood in the urine or a suspicion of a fistula (abnormal opening) between the bladder and vagina.
Urodynamic testing
This is state-of-the-art testing of the bladder function and pelvic muscle activity during bladder filling and emptying. It is used for women who fail a first-line treatment or for women in whom the most likely cause of the incontinence cannot be determined by other tests.
Pelvic ultrasound
This is used to check the female pelvic organs to look for fibroid tumors of the uterus or problems with the ovaries.