Diagnosis

During your visit, your doctor looks for clues that may 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
• Brief neurological exam to identify any pelvic nerve problems
• Urinary stress test, in which the doctor observes urine loss when you cough or bear down

Tests of bladder function

Common cases of urinary incontinence usually don't require additional tests. However, in some cases, your doctor might order tests to assess how well your bladder, urethra and sphincter are functioning (urodynamic tests).

Bladder function tests may include:

• Measurements of post-void residual urine. Your doctor may recommend this test if there's concern about your ability to empty your bladder completely, particularly if you are older, have had prior bladder surgery or have diabetes. This test can tell how well your bladder is functioning.

  A specialist uses an ultrasound scan, which translates sound waves into an image, to view 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. The catheter drains the remaining urine, which can then be measured.

• Measuring bladder pressures. Cystometry is a test that measures pressure in your bladder and in the surrounding region as your bladder fills. Your doctor may recommend this test to check for stress incontinence if you have had a neurologic disease of the spinal cord.

  A catheter is used to fill your bladder slowly with warm fluid. As your bladder fills, you may be asked to cough or bear down to test for leaks. This procedure may be combined with a pressure-flow study, which tells how much pressure your bladder has to exert in order to empty completely.

• Creating images of the bladder as it functions. Video urodynamics is a test that uses imaging to create pictures of your bladder as it's filling and emptying. Warm fluid mixed with a dye that shows up on X-rays is gradually instilled in your bladder by a catheter while the images are recorded. When your bladder is full, the imaging continues as you urinate to empty your bladder.
• Cystoscopy. This test uses a scope that is inserted into the bladder to look for blockages or any abnormalities in the bladder and urethra. This procedure is usually completed in the office.

You and your doctor should discuss the results of any tests and decide how they impact your treatment strategy.