What to Expect from a Continence Evaluation

The Agency for Health Care Policy and Research (AHCPR) clinical practice guideline recommends a basic evaluation for urinary incontinence. This evaluation, called baseline testing, identifies bladder and urethral dysfunction. The first and most important part of the evaluation and treatment of incontinence is to determine the problem. That is why the assessment of an incontinence problem should be referred to a clinician that has experience in the diagnosis and treatment of incontinence.

Components of a Basic Continence Evaluation

The basic evaluation should include a history, physical examination, estimation of post-void residual (PVR) urine volume, and urinalysis.

History

The clinician should thoroughly and carefully question you about your symptoms and urinary habits. Questions asked include:

• Do you ever leak urine when you don't want to?
• Do you lose or leak urine when you laugh, cough, sneeze, lift heavy objects, walk, or sleep?
• Do you leak urine when you workout or do exercises?
• Do you lose urine on your way to the bathroom?
• Do you dribble urine after you void?
• Do you wet the bed at night?
• Do you use absorbent pads or diapers to collect your urine?
• How often do you urinate?
• How many times during the night do you get up to go to the bathroom?

Your also contains a record of conditions which have a direct effect on the causes of your incontinence. Areas that relate to urinary incontinence (UI) include:

• Radiation therapy to the pelvic area.
• Reoccurring urinary tract infections.
• Previous incontinence treatment.
• For women, the number of pregnancies and births, weight of child, episiotomy, etc.
• For men, prostate surgery or prostate enlargement.

A bladder diary or bladder record pinpoints the frequency and pattern of incontinence episodes. Usually certain key areas are recorded:

• Times you urinated.
• Each time you had an incontinence episode and the amount of leakage.
• Activity you were doing when the incontinence occurred.
• The type and amount of liquid intake.

Physical Examination

To determine the existence and extent of an incontinence problem, a physical examination is necessary. It should include the following:

• General examination: During a general examination, the clinician can detect conditions such as edema (swelling in legs and feet) and neurologic abnormalities. In frail or impaired patients, the clinician checks mobility, memory, and manual dexterity.
• Abdominal examination: An abdominal exam is performed to listen for bowel sound, and to detect masses, bladder fullness, or tenderness above the pubic bone area.
• Pelvic examination in women: In women, a complete pelvic examination allows the clinician to determine the presence of atrophic (wasting away of muscles and tissue) changes, pelvic organ prolapse (dropping or falling of pelvic organs), skin condition, and any changes in the vagina, uterus, or bladder.
• Rectal examination: A rectal exam is performed to assess for hard stool, rectal sphincter tone, and sensation. In men, the rectal examination should also include an assessment of the size and shape of the prostate.
• Genital examination in men: In men, an examination to detect abnormalities of the penis, scrotum and skin is performed.
• Provocative Stress Test: The clinician will directly observe the incontinence by performing a provocative stress test to see the amount of urine that is leaking. With a full bladder, you will be asked to stand and cough vigorously three times. If immediate leakage occurs, then stress UI is likely. If leakage does not occur immediately, other types of UI may be present.

Urinalysis

Urinalysis is a test which measures the amount of blood, sugar, protein, and bacteria in your urine. Specimens for urine testing are collected by urinating in a container or by catheterization. If an infection is suspected from the urinalysis, a urine culture will be sent for laboratory analysis.

Estimation of PVR Volume

The next baseline test is to determine a post-void residual (PVR) urine volume, the amount of urine left in the bladder after voiding. PVR volume is checked within five to ten minutes after urination. There are two methods that are used to check PVR - catheterization and ultrasound. Persons who have increased PVRs and who have repeated bladder infections may need to see a specialist.

Other Specialized Tests

Additional tests, such as urodynamics, videourodynamics, ultrasounds, and/or x-rays of the kidneys and bladder, are performed in the following situations:

• Diagnosis is not certain.
• Treatment has failed.
• Hematuria (blood in the urine).
• Additional medical problems such as recurrent urinary tract infections, difficult bladder emptying, severe pelvic organ prolapse, enlarged prostate, and increased PVR.
• Planned surgery.