If a person with urinary incontinence visits a doctor, he will first discuss the history of bladder weakness in a conversation, perform a physical examination and, if necessary, carry out or initiate further diagnostic measures.
Detection / investigations
The doctor talk. Questions that the doctor asks:
- Since when do you suffer from bladder weakness?
- How often do you lose urine without wanting it? How much urine do you lose?
- Does the loss of urine occur in certain situations, eg physical strain?
- Do you often feel a strong urge to urinate?
- How many times a day and at night do you need to go to the toilet?
- Do you have the feeling that you can not completely empty your bladder?
- Do you have pain when urinating?
- Is the urine bloody?
- Did you have surgery before bladder failure?
- Are you currently suffering from other diseases?
- Do you regularly take medication? - Which?
The physical examination
After the anamnesis, the doctor makes an orienting picture through a general physical examination. This includes above all the palpation and delimitation of the bladder and the surrounding organs. In women, evaluation of the pelvic floor muscles is necessary in men of the prostate. A urine sample is examined in the laboratory for bacteria, protein, red or white blood cells. Are other diseases, such. As a cystitis, these must be treated first. A bladder cancer must not be overlooked.
Ultrasound examination (sonography) is a routine, painless and side-effect-free examination technique that visualizes internal organs on a monitor. Here, the location of the kidney and the urinary tract, findings such as kidney or bladder stones, tumors or congenital malformations can be determined. The emptying function of the bladder is also easily controlled with the aid of ultrasound. The illustration of the filled and then the emptied bladder gives information about the filling volume and about the possible amount of residual urine; but also about the bladder contour, including any irregularities (bladder cancer!). An examination of the prostate is also well possible with an ultrasound examination through the rectum.
The patient empties his bladder into a measuring funnel or on a special toilet seat. Connected gauges register the excreted amount of urine per second and determine a urine flow curve. The doctor identifies bladder emptying disorders or obstructions due to urethral narrowing or prostate enlargement.
Bladder and sphincter function diagnostics (urodynamics)
Bladder activity and sphincter function can be measured and documented by simultaneously measuring the pressure in the bladder via a bladder catheter and the urine flow as a function of the bladder filling. This study is indispensable if a clear distinction between stress and urge incontinence with simple clinical examinations is not possible or if surgery is planned.
X-ray examination (rarely necessary)
To visualize the kidneys, the bladder and the urinary tract in the radiograph, a contrast agent is required. Depending on the question, this can be passed via the veins into the bloodstream, filled into the bladder via a catheter or even through the ureters to the renal pelvis.
A bladder reflex allows viewing of the bladder and prostate from within through an endoscope inserted through the urethra. In this way, the doctor assesses the condition of the bladder mucosa (inflammation) and determines whether there are stones, tumors or abnormalities. The decision on the need for such an examination should be made by a specialist (urologist); in case of suspected bladder cancer, it is unavoidable.