Urinary Incontinence In Women: Exams And Tests

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Exams and Tests

To diagnose the cause of your urinary incontinence, your health professional will ask about your medical history and conduct a physical examination, including a pelvic exam. Your health professional may ask you to cough while you are standing to check for stress incontinence. In addition, a urinalysis and urine culture may be done to see if you have a urinary tract infection (UTI).

An accurate diagnosis is very important, because treatment based on an incorrect diagnosis may not help your incontinence and could even make it worse.

Your health professional will ask you about your symptoms and habits; for example, how often you need to urinate, when you leak urine, how much fluid and what kinds of fluids you drink, and whether you have any other symptoms along with incontinence. Your answers will provide clues about the cause of your incontinence.

Ideally, you will bring your doctor a 3- to 4-day diary of what and how much you drink, and how often and how much you urinate and leak. The pattern of your urine leakage may point to the type of incontinence.

View and print a voiding log (What is a PDF document?).

Other procedures that may be done include:

• Bladder stress test and Bonney test. For the bladder stress test, your health professional will insert fluid into your bladder and then check for leaking after asking you to cough. The Bonney test is similar to the bladder stress test except the bladder neck is lifted slightly with a finger or instrument inserted into your vagina while the bladder stress is applied.
• Pad test. A pad test can show how much urine you are passing and how often throughout the day. This is helpful when incontinence cannot be triggered during an exam.

Urodynamic testing

Urodynamic testing is expensive. It is generally done only if surgery is being considered or if treatment has not worked for you and you need to know more about the cause. It provides a more advanced way to check bladder function. Urodynamic testing may be done if the above tests do not give an answer to why you have leakage of urine or your health professional suspects that you have mixed incontinence with more than one cause. The actual tests done in urodynamic testing often vary. They may include:

• Cystometry (cystometrography, uroflowmetry), which is a series of tests to measure bladder pressure at different levels of fullness. Cystometry is helpful in diagnosing urge incontinence.⁴ Cystometry tests include:
  • Leak point pressure (LPP), which measures weakness in the muscle that holds back urine (sphincter).
  • Maximum urethral closure pressure (MUCP), which measures the pressure keeping the urethra closed naturally.
• Postvoid residual (PVR) measurements and X-rays or ultrasound. These are used to examine changes in the position of the bladder and urethra during urination, coughing, or straining.

If the underlying cause of incontinence is not identified by the above tests, more extensive tests may be needed. The following tests are not routinely done to diagnose urinary incontinence.

• Cystoscopy uses a scope to look inside the urethra and the bladder for abnormalities.
• Voiding cystourethrogram is an X-ray that uses an iodine-containing contrast liquid to show the shape of the lower urinary tract (bladder and urethra). This may make visible any physical abnormalities of the urinary tract that could be contributing to incontinence.

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Last updated:	September 22, 2006
Author:	Kathe Gallagher, MSW
Reviewed By:	Martin Gabica, MD - Family Medicine, Avery L. Seifert, MD - Urology
Editors:	Kathleen M. Ariss, MS, Terrina Vail