Evaluation of Urinary Incontinence. Urinary incontinence does not usually indicate a life-threatening condition; however, it can cause embarrassment or cause people to restrict their activities unnecessarily, lowering their quality of life. Sudden incontinence can also be an indication of a spinal cord problem in rare cases. The following information can assist people in determining when a doctor’s evaluation is required and what to expect during the evaluation.
Signs to be aware of
Certain signs and characteristics in patients with urine incontinence are cause for concern. They include the following:
Damage to the spinal cord can cause a variety of symptoms (for example, weakness in the legs or loss of sensation in the legs or around the genitals or anus)
When should you see a doctor?
People who see warning symptoms should go to an emergency room right away. Call your doctor if you don’t see any warning signals. Based on their other symptoms and other known problems, the doctor will determine how soon they need to be seen. In most cases, if incontinence is the sole symptom, a week or so wait is not hazardous.
Most people are embarrassed to tell their doctors they have incontinence. Some people think incontinence is a natural part of growing older. Treatment for incontinence, even if it has been present for a long time or happens in an older person, may be beneficial. People should contact a doctor if urine incontinence symptoms are uncomfortable, interfere with daily tasks, or force them to limit their social activities.
What the physician does
Doctors begin by inquiring about a patient’s symptoms and medical history. A physical examination is next performed by the doctors. What they discover during the history and physical examination frequently points to a cause of incontinence and the testing that may be required.
Doctors inquire about the conditions of urine loss, such as the amount of pee lost, the time of day, and any precipitating events (such as coughing, sneezing, or straining). People are asked if they can feel the desire to urinate and, if so, if the sensation is typical or if it occurs suddenly. Doctors could also ask the patient to estimate how much pee is leaking. Doctors will also inquire about any additional urinary issues, such as urination pain or burning, a frequent urge to urinate, trouble commencing urination, or a weak urine stream.
Doctors may encourage patients to keep track of their urine patterns for a day or two. A voiding diary is a name for this type of record. The volume and time of each urination are kept track of. Following an incontinence episode, the person keeps track of any connected actions, such as eating, drinking, drug usage, or sleep.
Doctors inquire about other conditions that can cause incontinence, such as dementia, stroke, urinary tract stones, spinal cord or other neurologic diseases, and prostate disorders. Because some drugs cause or contribute to incontinence, doctors need to know what drugs a person is taking. Women are questioned about the number and types of deliveries they have had, as well as any difficulties. Prior pelvic and abdominal surgery, particularly prostate surgery in men, is inquired about by everybody.
A physical examination can assist doctors in determining the root of the problem. Doctors assess leg strength, feeling, and reflexes, as well as sensation around the genitals and anus, to look for nerve and muscle abnormalities that could make it difficult for the patient to stay seated.
Doctors perform a pelvic examination on women to look for abnormalities that could lead to incontinence, such as vaginal atrophy (menopausal changes in which the lining of the vagina becomes thinner, drier, and less elastic, sometimes accompanied by urinary tract changes) or pelvic muscle weakness. Doctors perform a rectal examination on both men and women to look for signs of constipation or injury to the nerves that feed the rectum. In men, the rectal examination allows doctors to assess the prostate, which can cause incontinence if the prostate is big or if prostate cancer is present. To see if stress incontinence is present, the client may be instructed to cough with a full bladder. During a pelvic examination, women may be asked to repeat this process to test if supporting some pelvic structures (with the doctor’s fingers) stops urine leakage.
Testing
Findings during a physical examination can often aid doctors in determining the cause of incontinence or identifying variables that contribute to it. However, some tests are frequently required in order for doctors to provide a definitive diagnosis. Tests that are routinely obtained include:
- Urine culture and urinalysis
- Kidney function tests, as well as other testing, are sometimes performed.
- leftover volume after voiding (a catheter or ultrasonography probe is used to determine how much urine is left in the bladder after a person urinates)
- Urodynamic testing is used in some cases.
When clinical evaluation and the aforementioned procedures fail to uncover the reason of incontinence, urodynamic testing is used. Urodynamic testing comprises cystometry, urine flow rate testing, and cystometrography.
Cystometry is used to confirm urge incontinence and rule out hyperactive bladder as a cause. Through the urethra, a bladder catheter is inserted. A doctor determines how much water can be injected into the bladder until a sense of urgency or bladder contractions arise.
In men, the peak urine flow rate is evaluated to see if incontinence is caused by a blocked bladder outlet (usually caused by prostate disease). Men urinate into a uroflowmeter, which measures the rate of urine flow and the amount of urine released.
Urge incontinence is confirmed with cystometry, which determines whether the reason is an overactive bladder. The urethra is used to insert a bladder catheter. A doctor determines the amount of water that can be injected into the bladder until the patient feels a sense of urgency or bladder contractions.
In order to evaluate whether incontinence is caused by a blocked bladder outlet, men’s peak urine flow rate is measured (usually caused by prostate disease). Men urinate into a specific instrument called a uroflowmeter, which measures the rate of urine flow as well as the amount of urine released.