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Tests and diagnosis
By Mayo Clinic staffIn a basic diagnostic workup, your doctor will look for clues that may also indicate contributing factors. The exam will likely include:
- A medical history
- A physical examination with particular focus on your abdomen and genitals
- A urine sample to test for infection, traces of blood or other abnormalities
- A focused neurological exam that may identify sensory problems
Specialized tests
Your doctor may order urodynamic tests, which are used to assess the function of your bladder and its ability to empty itself steadily and completely. These tests usually require a referral to a specialist in urinary disorders in men and women (urologist) or urinary disorders in women (urogynecologist). Tests include:
- Measurements of postvoid residual urine. When you urinate or experience urinary incontinence, your bladder may not empty completely. The remaining urine volume (postvoid residual urine) may cause symptoms identical to an overactive bladder. To measure residual urine after you have voided, a thin tube (catheter) is passed through the urethra and into your bladder. The catheter drains the remaining urine, which can then be measured. Alternatively, a specialist may use an ultrasound scan, which translates sound waves into an image of your bladder and its contents.
- Uroflowmetry. A uroflowmeter is a device into which you urinate to measure the volume and speed of your voiding. This device translates the data into a graph of changes in your flow rate.
- Cystometry and pressure-flow studies. Cystometry measures bladder pressure during filling. Pressure-flow studies measure the amount of pressure needed to urinate and the speed of the urine flow. A catheter is used to fill your bladder slowly with water. Another catheter with a pressure-measuring sensor device will be placed in your rectum or for women, in your vagina. This procedure can identify any involuntary muscle contractions, indicate the level of pressure at which you feel an urge or experience leakage, and measure pressure needed to empty your bladder.
- Electromyography. Electromyography assesses the coordination of nerve impulses in the muscles of the bladder and the urinary sphincter. Sensors are placed either on or in the skin in your pelvic floor.
- Video urodynamics. These procedures use either X-ray or ultrasound waves to create pictures of your bladder in combination with cystometry and a pressure-flow study as your bladder is filling and emptying. Your bladder is filled with the use of a catheter, and you urinate to empty your bladder. The fluid will contain a special dye that's detected by X-ray technology.
- Cystoscopy. A cystoscope, a thin tube with a tiny lens, enables your doctor to see the inside of your urethra and bladder. With the aid of this device, your doctor can check for abnormalities in your lower urinary tract, such as bladder stones or tumors.
Your doctor will review the results of these tests with you and suggest a treatment strategy.
