Whatever the cause of incontinence, early medical advice should be sought.

The tests that your doctor advises will establish the cause so that an effective treatment programme can be implemented.  The investigation of incontinence follows a series of stages.

Initial questioning

Your doctor will ask specific questions relating to the frequency and urgency of urination.  Your medical history will be taken to determine what causes or aggravates the condition.  To follow on from this, a urine sample will be required for analysis, and possibly a blood sample.

Urine and blood tests

Urinalysis (examination of urine) in many cases will be used to look at the cause of incontinence - for example, to see whether there is an infection present.  The test carried out at the GP's surgery is the 'dipstick test'.  Alternatively, the sample is sent off to the local hospital laboratory for more detailed testing.

A blood sample will be taken if your GP needs to investigate the possibility of kidney disease or diabetes as underlying causes.  Calcium levels present in blood may be analysed as high blood calcium causes increased production of urine, aggravating any incontinence problem.

Physical examination

If an infection is diagnosed, further tests will be carried out.  Your doctor or specialist (urologist) will usually conduct a pelvic and rectal examination to look for anatomical causes.

For men who appear to have overflow incontinence, the possibility of an enlarged prostate will need to be investigated through means of a rectal examination.  This involves insertion of a lubricated gloved finger into the rectum.

For women, a vaginal examination will determine if there are weaknesses in the vagina or pelvic muscles.  A perineometer, which consists of a vaginal probe and a gauge, may be used to assess muscle strength on squeezing.  The physical assesment can detect a uterine prolapse or urinary fistula.

X-rays

An X-ray will be taken if the incontinence may be due to problems specifically with the kidneys or bladder.

Flow tests

A flow test will be conducted at the hospital if required.  These are detailed assessments, taking about an hour, to see how well the bladder is able to hold urine.

Bladder examination

A consultant urologist will carry out an examination of the bladder if required. Urodynamics provides an evaluation of bladder function (sensation, detrusor and sphincter function) through various tests such as cystometry and cystoscopy.  The completion of a urine frequency/volume chart before the test is undertaken is usually required.

Cystometry measures the pressure changes inside the bladder when it is filled with volumes of fluid.  It provides information on normal and abnormal bladder function.  The test takes about 20 minutes, on an outpatient basis at the hospital.  It involves the insertion of a catheter into the bladder through the urethra, but no anaesthetic is required.

A device connected to the catheter is responsible for gathering the required information, including the amount of residual urine in the bladder after urinating.  The test can detect poor bladder emptying and conditions when nerve control of the muscles has been affected, i.e. due to diabetes.

A cystoscopy is a test that investigates both bladder and urethra function.  It obtains a direct view of any bladder abnormalities and can detect stones, tumours and sites of bleeding.  The test is carried out under local or general anaesthetic and involves inserting a small optical device, a fibreoptic tube, into the bladder via the urethra.  A radiopaque dye can be injected which allows X-rays to be taken.  A cystoscopy is also used in the treatment of incontinence.

Once relevant results have been obtained, a clearer indication of appropriate treatments will become evident.

20/05/2009