We may need to perform some tests to diagnose urinary incontinence.
The urologist will take your medical history and do a physical examination. We will need to examine your genitalia regions. If required, other tests will be performed.
The doctor will take a detailed medical history and ask questions about your symptoms. You may be asked the following questions:
The urologist will do a general physical examination on:
Grading of urinary incontinence:
Stress incontinence can be broadly divided into 3 grades in terms of severity.
Grade 1 (mild): Leakage only occurs when there is severe abdominal straining e.g: coughing or sneezing. There is generally no need to use pads and there is no leakage during normal exercise and at night.
Grade 2 (moderate): Leakage occurs when there is moderate abdominal straining e.g: running or exercise. There may be a need to use pads and the number of leakages is greater than grade 1.
Grade 3 (severe): Leakage occurs when there is mild stress e.g: standing up from a sitting or lying down position. There is a need to use pads all the time as the number of leakage episodes are frequent and this has become a social or hygiene issues.
You will need to provide some of your urine for tests to exclude urinary tract infection and traces of blood in the urine.
You may be asked to keep a bladder diary. You can note down the amount you drink, how often you urinate, and how much urine you produce. The bladder diary is important because it helps your doctor to understand your symptoms better. You may be asked to purchase a measurement jug if you do not have one.
Urodynamic evaluation (UDS)
A urodynamic test is done to get more information about your urination process and to check if your bladder muscles/ urinary sphincters work well. During the test, your doctor inserts small catheters in your urethra and rectum to measure the pressure in your bladder and abdomen while fluid is being instilled into the bladder.
Uroflowmetry (only in selected cases and when necessary)
This is a simple test which electronically records the rate of urine flow. You will urinate into a container, called a uroflowmeter. This test helps your doctor to check whether there is any obstruction to the flow of urine.
Imaging of the bladder/kidneys (only in selected cases and when necessary)
You may have to get an ultrasound of the bladder and kidneys, which uses high-frequency sounds to create an image of your bladder/kidneys if necessary.
Cystoscopy (only in selected cases and when necessary)
If you have blood in the urine or an abnormal ultrasound finding of the bladder, you may be asked to undergo a flexible cystoscopy in the clinic. This day procedure allows urologist to look into your bladder to assess if you have any other conditions.
SUI are often bothersome but not life-threatening. In most cases, self-management is offered as the first step of treatment. Please discuss with your urologist. You can actively manage your symptoms. The following self-management measures may help you:
Medications may be required if self-management or lifestyle changes are inadequate to control the symptoms. A common medication is local estrogen application for postmenopausal females to improve the pelvic floor tissues.
For patients with grade 3 or severe incontinence, surgery may be offered. In general, these are the patients who have failed conservative treatment or who desire to have a good quality of life. Surgery may involve lifting up the urethra or to bulk up the sphincter muscle so that the closure mechanism improves. Additional surgeries to correct pelvic organ prolapse may also be necessary.
Here is a summary of surgeries commonly performed for female SUI:
Midurethral sling (MUS) - A strap/ribbon (synthetic mesh) that is placed under the urethra to provide support.
Autologous fascial sling - A strap/ribbon made from the patient's own body tissue (harvested from the abdomen or thigh) that is placed under the urethra to provide support.
Burch colposuspension - An operation to support the bladder neck, which connects the bladder to the urethra, to resist pressure
Bulking agents - Substance that is injected into the walls of the urethra to improve closure. Effects of this treatment is usually temporary and may need repeat procedures.
Artificial urinary sphincter (AUS)-An inflatable cuff placed around the urethra connected to a hand controlled pump that allows you to pass urine when released.
Please consult your doctor or nurse regarding any questions you may have about incontinence. You should not feel embarrassed about asking about any of your concerns.