The diagnosis is usually made after your doctor has taken a complete history and performed a thorough physical examination. Basic and further investigations will be planned depending on the initial assessment.
History taking involves asking you questions about your symptoms, details about your previous pregnancies, medical and surgical history and medications. Your doctor may also enquire about sexual history and how your condition may have affected your daily activities and quality of life. You may also be asked to complete a bladder diary for up to three days, including both working days and days off.
Abdominal and pelvic examination will be performed to assess for any possible tumours, co-existing pelvic organ prolapse, strength of pelvic floor muscle contraction or signs of vaginal atrophy. An erect stress test – where the patient will be asked to stand on an incontinence sheet and cough about 10 times, to assess for any urinary leakage, is usually performed. If necessary, a neurological examination may also be performed.
Further tests will be ordered after the doctor’s initial assessment.
Most commonly, a urine dipstick test to look for blood, glucose, protein, white blood cells and nitrites will be done. Urine cultures to exclude urinary tract infection may also be part of the initial assessment.
Post-void residual urine volume should be measured in women who have symptoms suggesting voiding dysfunction or recurrent urinary tract infections. This may be performed using a bladder scan or catheterisation.
For some people, urodynamics studies, a complex assessment of changes in bladder activity during filling and emptying, may be required to confirm the diagnosis and decide on treatment options, especially if surgery for urinary incontinence is considered.