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Urinary incontinence is a relatively common, and timely diagnosis is important to ensure symptoms are managed effectively. Additionally, as there can often be an underlying cause that leads to incontinence symptoms, it is essential that causes are not overlooked so that they can be managed effectively.

Type of Urinary Incontinence

In the diagnosis of urinary incontinence, establishing the type of incontinence is essential to understand the causative factors and to decide upon the optimal management plan.  

Types of incontinence include:

• Stress incontinence involves leakage of urine when the abdomen and bladder are pressed, such as during coughing, laughing or heavy lifting. Weakening of pelvic muscles, after childbirth or local surgery, is a common causes and explains why it is more common in women.

• Urge incontinence is characterized by a sudden need to urinate, without allowing enough time to reach a toilet. This is usually caused by a urinary tract infection or overactive bladder and is more common in elderly people.

• Overflow incontinence occurs when patients have difficulty voiding their bladder completely and leads to loss of urine when the bladder becomes overfilled. It is often caused by enlarged prostate and affects more men than other types.

• Functional incontinence involves a problem external to the urinary tract that limits the individual’s ability to reach a toilet in time, such as arthritis.

• Mixed incontinence occurs as a result of multiple causes and includes a combination of different incontinence types. As a result, it often requires a more complex treatment plan.

Medical History

Upon initial consultation with presenting symptoms, a detailed history of incontinence symptoms should be recorded, along with and relevant health conditions or medications.

It may be useful for patients to keep a diary or their urinary movement for a period of time, perhaps a week, to describe an overall picture of how the condition is affecting their life. Fluid intake, times to void in bathroom and any incidences of incontinence should be recorded. This can assist greatly in diagnosing which type of incontinence is responsible for symptoms and choosing a coherent treatment.

Several factors that are important to note when taking a medical history are:

• Frequency of urination
• Instances of urinary incontinence
• Fluid intake
• Difficulty when passing urine
• Pharmacological drug use
• Recent surgery
• Ill health and other conditions

Physical Examination

Following the detailed history, a physical examination of the urinary tract may help to understand specific reasons for the symptoms of incontinence.

A blockage in the urinary tract, such as an enlarged prostate gland or other tumor, may be obstructing the passage of urine. Severe cases of constipation can put pressure on the bladder, forcing the muscles to contract earlier than they should. Finally, evidence of poor reflexes or sensations in the area may be indicative of damage to the nervous system.

If it is suspected that the patient suffers from stress incontinence, this may be physically examined by asking the patient to cough vigorously while evidence of incontinence is monitored.

Diagnostic Tests

There are several types of tests that may be beneficial in the diagnosis of urinary incontinence. The most commonly used tests include:

• Dipstick test urinalysis uses a urine sample to test for the presence of bacteria that indicate a urinary tract condition, a common cause of incontinence.

• Residual urine test is used when overflow incontinence is suspected, as it quantifies the volume of urine remaining in the bladder immediately after the patient has relieved himself or herself.

• Cystoscopy involves a flexible tube that is inserted into the urinary system that allows any internal abnormalities to be viewed by way of a miniature camera.

• Urodynamic tests are a combination of several tests that give an overview of bladder and urethra function. It may include a bladder diary, bladder and abdomen pressure measurements, as well as urine flow tests.

Referral

It is best for patients with urinary incontinence to be referred to a medical profession that specializes in this field, such as a urologist. A gynecologist may be able to provide more specific advice about the female urinary system, particular in regards to symptoms of incontinence following childbirth.

References

• http://www.aafp.org/afp/2013/0415/p543.html
• http://www.emedicinehealth.com/incontinence/page4_em.htm
• http://www.everydayhealth.com/womens-health/incontinence/diagnosing-urinary-incontinence.aspx
• http://umm.edu/health/medical/reports/articles/urinary-incontinence
• http://www.nhs.uk/Conditions/Incontinence-urinary/Pages/Diagnosis.aspx

Further Reading

• All Urinary Incontinence Content
• What is Urinary Incontinence?
• Types of Urinary Incontinence
• Urinary Incontinence Treatments
• Urinary Incontinence in Children

Written by

Yolanda Smith

Yolanda graduated with a Bachelor of Pharmacy at the University of South Australia and has experience working in both Australia and Italy. She is passionate about how medicine, diet and lifestyle affect our health and enjoys helping people understand this. In her spare time she loves to explore the world and learn about new cultures and languages.