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Tests and diagnosis
By Mayo Clinic staffIn a basic diagnostic work-up, 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 or abnormal reflexes
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:
- Measuring urine left in the bladder. When you urinate or experience urinary incontinence, your bladder may not empty completely. The remaining urine (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 a measurement of the amount of urine remaining in your bladder.
- Measuring urine flow rate. 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.
- Testing bladder pressure. 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 is placed in your rectum or for women, in your vagina. This procedure can identify involuntary muscle contractions, indicate the level of pressure at which you feel an urge or experience leakage, and measure pressure used to empty your bladder.
- Measuring bladder nerve impulses. 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.
- Creating images of bladder function. Video urodynamics 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 using a catheter, and you urinate to empty your bladder. The fluid contains a special dye that's detected by X-ray technology.
- Looking inside the bladder. 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.
References
- Cartwright R, et al. Current management of overactive bladder. Current Opinion in Obstetrics and Gynecology. 2008;20:489.
- Carr RJ. Urinary incontinence. In: South-Paul JE, et al. Current Diagnosis and Treatment in Family Medicine. 2nd ed. New York, N.Y.: McGraw Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3036304. Accessed Aug. 2, 2010.
- Tanagho EA, et al. Urinary incontinence. In: Tanagho EA, et al. Smith's General Urology. 17th ed. New York, N.Y.: McGraw Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3129492. Accessed Aug. 2, 2010.
- Overactive bladder. American Urological Association. http://www.urologyhealth.org/adult/index.cfm?cat=03&topic=450. Accessed Aug. 2, 2010.
- What I need to know about Bladder Control for Women. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/kudiseases/pubs/bcw_ez/. Accessed Aug. 2, 2010.
- Ellsworth PI, et al. Frequently asked questions in the evaluation and management of overactive bladder. Journal of Family Practice. 2009;58supp:1.
- Hartmann KE, et al. Treatment of overactive bladder in women. Agency for Healthcare Research and Quality. http://www.ahrq.gov/downloads/pub/evidence/pdf/bladder/bladder.pdf. Accessed Aug. 2, 2010.
- DuBeau CE. Clinical presentation and diagnosis of urinary incontinence. http://www.uptodate.com/home/index.html. Accessed Aug. 2, 2010.
- Urodynamic testing. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/kudiseases/pubs/urodynamic/. Accessed Aug. 2, 2010.
- DuBeau CE. Treatment of urinary incontinence. http://www.uptodate.com/home/index.html. Accessed Aug. 2, 2010.
- Anger JT, et al. Outcomes of intravesical botulinum toxin for idiopathic overactive bladder symptoms: A systematic review of the literature. The Journal of Urology. 2010;183:2258.
- Lightner DJ (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 4, 2010.
- Subak LL, et al. Weight loss to treat urinary incontinence in overweight and obese women. New England Journal of Medicine. 2009;360:481.
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