Diagnosis

If you have an abnormal urge to urinate, your doctor will check to make sure that you don't have an infection or blood in your urine. Your doctor may also want to make sure that you're emptying your bladder completely when you urinate.

Your doctor will look for clues that might also indicate contributing factors. Your appointment will likely include a:

• Medical history
• Physical exam, which may include a rectal exam and a pelvic exam in women
• Urine sample to test for infection, traces of blood or other abnormalities
• Focused neurological exam that may identify sensory problems or abnormal reflexes

Tests of bladder function

Your doctor may order tests to assess how well your bladder is functioning and its ability to empty steadily and completely (urodynamic tests). These tests usually require a referral to a specialist and may not be necessary to make a diagnosis or begin treatment. Urodynamic tests include:

• Measuring urine left in the bladder. This test is important if there's concern about your ability to empty your bladder completely when you urinate. Remaining urine in the bladder (post-void residual urine) may cause symptoms identical to those of an overactive bladder.

  To measure residual urine after you have voided, your doctor may request an ultrasound scan of your bladder. The ultrasound scan translates sound waves into an image, showing how much urine is left in your bladder after you urinate. In some cases, a thin tube (catheter) is passed through the urethra and into your bladder to drain the remaining urine, which can then be measured.

• Measuring urine flow rate. To measure the volume and speed of your voiding, you may be asked to urinate into a device (uroflowmeter). A uroflowmeter catches and measures the urine, and translates the data into a graph of changes in your flow rate.

• Testing bladder pressures. Cystometry is a test that measures pressure in your bladder and in the surrounding region as your bladder fills. During this test, your doctor uses a thin tube (catheter) to fill your bladder slowly with warm fluid. Another catheter with a pressure-measuring sensor is placed in the rectum or, for women, inthe vagina. The sensor tells how much pressure your bladder has to exert to empty completely.

  This procedure can identify whether you have involuntary muscle contractions or a stiff bladder that's not able to store urine under low pressure.

Your doctor will review the results of any tests with you and suggest a treatment strategy.