Generally undergo a diagnostic protocol to determine the type of urinary incontinence that the patient has that includes:
Medical history. It will be review your family history, the diseases you have had, the course of any past pregnancies or births, and whether you have had any gynaecological problems. They will also interview you to learn about your symptoms and to identify risk factors: if you drink too much fluid, if you consume stimulating drinks (coffee, tea, etc.), if you are following a treatment with any medicines that can cause incontinence (e.g., diuretics), or alternatively retain urine, (e.g., antidepressants).
Symptom questionnaires. You will be asked to complete some short questionnaires to make the best possible evaluation of the symptoms.
Physical examination. To detect physical abnormalities that could be related to the incontinence, such as potentially associated problems (scars from previous operations, abdominal hernias, skin lesions, etc.).
A urine sample is analysed to rule out a urinary infection. If positive, the germ causing the infection is identified and the appropriate antibiotic therapy applied.
Urinary diary or bladder record. A urinary diary is a daily record of the number of urinations and leaks, and the volume of fluid consumed. It helps the doctor to better understand your urinary incontinence and also identify behavioural habits that can be modified to achieve a significant improvement in the symptoms.
How to record a urinary diary
Use the urinary diary to record the volumes of liquids you drink and at what times over a 3 day period. You should also make a note of every time you urinate, recording the time and volume of urine discharged (with the help of a measuring device).
Similarly, you need to record the times of any losses of urine, and the time at which you get up and go to bed to calculate how many times you urinate each night.
Depending on the symptoms and physical examination, there are other diagnostic tests that can provide further information about the cause of the urinary incontinence.
Residual urine measurement. Ultrasound is a straightforward, painless technique used to determine the volume of residual urine, i.e., the amount remaining in the bladder after urinating naturally.
Urodynamic study. This is the key test for identifying the exact type of urinary incontinence and diagnosing other urinary dysfunctions. It is designed to measure how the bladder functions while it fills with liquid and when urinating.
Pelvic floor ultrasound. This is a simple, painless test that evaluates the shape of the urethra (passageway through which urine is discharged), the bladder and the pelvic floor muscles.
Cystoscopy. This technique provides an internal view of the bladder and urethra.
Kidney/bladder ultrasound. This test is used to evaluate the anatomy and morphology of the bladder, urinary tract and kidneys, in order to rule out lithiasis (stones).
Women with urinary incontinence usually undergo a pelvic examination in the same position as when they are examined by a gynaecologist. It is important that the bladder is full (drink 2–3 glasses of water before attending the appointment).
During the examination the doctor will examine the external genitals (vulva and entrance of the vagina), the urethral meatus (hole from which urine is discharged) and the internal genitals (vagina and cervix) with the aid of a retractor like the ones used in gynaecological check-ups.
To learn whether urine leaks upon exertion, the patient is asked to cough. The specialist will also perform a digital vaginal examination (by introducing a finger inside the vagina) to assess any loss of support to the urethra (passageway through which urine is discharged), any scars from prior surgery, whether there is genital prolapse (i.e., if any pelvic organs, such as the uterus, bladder or rectum, have descended from their normal positions) and the contraction capacity of the pelvic floor muscles.
Women who also suffer leaks of gases or faeces may need to undergo a digital rectal examination (introducing a finger through the anus) to evaluate anal sphincter tone (the muscle that contracts to retain faeces).
Which professional should I consult?
Healthcare professional (doctor, nurse, etc.) should aim to detect (ask if you suffer urine losses) and provide information about incontinence problems. It could be either a family doctor or specialist in general gynaecology or urology that diagnoses the type of urinary incontinence and indicates the initial treatment.
Gynaecology and urology departments include professionals who are experts in pelvic floor disorders. A urogynaecologist is a doctor who specialises in gynaecology or urology and is either preferentially or exclusively dedicated to the diagnosis and treatment of pelvic floor disorders, such as incontinence and pelvic organ prolapse.
Many medical centres currently have urogynaecology units (also called pelvic floor units) where gynaecologists, urologists, nurses and other specialists work in collaboration to provide comprehensive attention to women with these health problems.