Making the Diagnosis

There are several different kinds of doctors that treat urinary incontinence. This could be an internist, gynecologist, urologist (a surgeon specializing in the urinary tract), urogynecologist (a gynecologist with specialty training in female organ prolapse and incontinence), or even a physiatrist—a doctor who specializes in rehabilitation. Physical therapists are also key members of the team in the treatment of incontinence because of their expertise in retraining pelvic floor or Kegel muscles, which are often the culprit in urinary incontinence.

Your doctor will ask you several questions about your general health history, details about your incontinence, and problems with pelvic pain and your sex life. Often a physician may ask you to complete a “bladder diary” where you record your fluid intake, number of urinations, amounts and loss of control day and night. This information can provide a real life sample of one’s day to day bladder experience.

A physical examination that includes a pelvic exam will be performed. During the pelvic examination, the pelvic floor muscles can be assessed for tenderness, weakness, or coordination problems. Strength may be defined using the Modified Oxford Scale:

Score Description:
0/5: No discernable contraction of muscles
1/5: Flicker or pulsation is felt; no discernable lifting or tightening
2/5: Weak contraction; no discernable lifting or tightening
3/5: Moderate; some lifting of posterior (back) wall and some tightening around the examiner’s finger, contraction is visible
4/5: Good; elevation of the vaginal wall is felt against resistance, drawing in of the perineum is felt, able to hold for 5 or more seconds
5/5: Strong resistance is felt; if two fingers are inserted, fingers will be approximated—able to hold for 10 seconds

Note:   testing is performed in 4 quadrants
 Anterior (front) to assess contraction around urinary sphincter
 Right
 Left
 Posterior (back) to assess contraction around anal sphincter

A Q-tip may be inserted into the urethra to see how it moves when the patient strains or bears down. This provides information about the support structures of the pelvis.

Next, a sample of urine will be collected and a urinalysis will be done. This is where the urine is checked for blood, glucose or sugar for diabetes, and any sign of infection. If the urine has signs of infection it will be sent for a urine culture where infection is definitively diagnosed. This is the only way a doctor can be absolutely sure there is a true infection. The amount of urine left in your bladder after you urinate will be measured. This is called a post void residual. A more detailed assessment of your bladder and muscles can also be done with a test called urodynamics. During this test a catheter or tube will be placed into the bladder to determine what kind of incontinence is present, especially if your health history or physical exam needs greater clarification. A cystoscopy may also be performed which is when a camera is placed into the bladder via a telescope-like device. This gives the doctor a chance to see the bladder tissue and rule-out cancers that can cause bladder symptoms as well. A physician may order other tests to help check the anatomical structures more clearly such as an ultrasound or CT scan.