Current Investigations

Medical History

During the medical history, your health professional will ask you to describe:

  • How long you have had incontinence.
  • What, if anything, you are doing (laughing, coughing, or changing posture) when you experience incontinence.
  • How often you have the problem and how much urine you lose.
  • Risk factors you may have, such as ongoing (chronic) bladder infections or prostatitis, that could lead to incontinence.
  • Your eating habits.
  • Your bowel habits, to determine whether chronic constipation may be contributing to incontinence.
  • Prescription and nonprescription medicines you take.
  • Treatments for previous problems affecting your urinary tract.
  • Your use of pads or other protective devices to control urine loss.
  • How much caffeine, alcohol, and other fluids you drink daily.

Your health professional will ask questions about your general health and specific questions about your urinary and reproductive tracts, intestines, and nervous system to find clues to the cause of the incontinence. He or she will also ask about conditions that are related to incontinence and previous treatment of urinary incontinence.

The Evaluation of Pelvic Floor Dysfunction

Basic evaluation

  • Carried out by a general practitioner, gynecologist, or urologist; suffices to establish the indication for initial conservative treatment, with antibiotic treatment of urinary tract infections (if necessary), pelvic floor exercises, behavior modification, or anticholinergic medication
  • History, including basic psychosomatic questions
  • Urinalysis to rule out infection
  • Determination of post-void residual volume
  • Micturition diary

Extended basic evaluation

  • Carried out by a gynecologist or urologist (with the aid of a psychiatrist and/or specialist in psychosomatic medicine, if indicated); suffices to establish the indication for a further trial of conservative treatment
  • Vaginal inspection (prolapse, local hormone deficiency, contractility of pelvic floor)
  • Perineal/introital ultrasonography (bladder neck mobility, bladder neck funneling, prolapse)
  • Clinical stress test (urine loss upon coughing while standing)
  • Urinary pad test

Special tests

  • Carried out by a specialist (perhaps at a specialized continence and pelvic floor center); necessary to establish the indication for a surgical procedure when conservative treatment has failed
  • Urodynamic testing
  • Cystoscopy
  • Spezialized perineal/introital ultrasonography
  • Endoanal intrasonography, if indicated
  • Dynamic magnetic resonance defecography, if indicated
  • Anal manometry

Quality of Life Questionnaire and Pad Test

You may be asked by your doctor to determine the frequency of accidents (daily, weekly, monthly, occasionally) if and how often you wear pads and if or how often incontinence forces you to modify your lifestyle by answering questions about different aspects of your problem (Quality of Life Questionnaire).

The patient is then given a urination (voiding) diary to be kept for three days, to document their fluid intake and output, including episodes of incontinence. This provides information about bladder capacity, the frequency of passage of urine and episodes of incontinence and getting up at night. A midstream specimen of urine is sent to the laboratory in order to exclude infection. A midstream specimen of urine is sent to the laboratory in order to exclude infection.

A pad test may be performed to determine the severity of any incontinence and objectively demonstrate the symptom. The patient drinks 500 ml of water and walks about performing normal everyday tasks while wearing a pre-weighed pad. The pad is then re-weighed and a gain of more than 1g per hour is taken to represent urinary incontinence. The diary can also outline other problems such as excessive fluid intake.

Radiological Investigations

Conventional imaging techniques such as dynamic cystoproctography are still widely used for assessing pelvic dysfunction, and there is no single imaging technique that is considered the reference standard.

Retrograde cystography: X-rays are taken of the bladder after it has been filled with a contrast which is a substance injected into the body allowing the particular organ or tissue under study to be seen more clearly. This examination allows the physician to assess the bladder’s structure and integrity.

Ultrasonography: noninvasive method of assessing bladder volume and other bladder conditions using ultrasonography to determine the amount of urine retention or post-void residual urine. Bladder ultrasound may be used in rehabilitation for bladder assessment and training.

Perineal ultrasound: ultrasound is superior for pelvic floor imaging, especially in the form of perineal or translabial imaging. The technique is safe with no radiation, simple, cheap, easily accessible and provides high spatial and temporal resolutions. Translabial or perineal ultrasound is useful in determining residual urinary volume, detrusor wall thickness, bladder neck mobility and in assessing pelvic organ prolapse as well as levator function and anatomy.

MRI: is particularly well suited for global pelvic floor assessment including pelvic organ prolapse, defecatory function, and pelvic floor support structure integrity.

An MRI study of the pelvic floor is noninvasive and useful for presurgical evaluation of a cystocele. Rapid sequence dynamic MRI offers an excellent view of all the pelvic organs and musculofascial support structures and causes minimal patient discomfort. An MRI study provides additional information beyond the physical exam, which is especially helpful in patients who have a great deal of pain as well as prolapse. An MRI doesn't subject patients to the radiation involved in evacuation proctography or positive contrast peritoneography.

Defecography is a radiological test that allows the doctor to visualize what occurs when you are emptying your rectum. Defecography is the radiographic examination of the operation of the defecation process under fluoroscopy.

Cystoscopy is usually carried out with local anaesthesia. When a patient has a urinary problem, the doctor may use a cystoscope to see the inside of the bladder and urethra. The cystoscope has lenses which let the doctor focus on the inner surfaces of the urinary tract.

Anorectal physiology and ultrasound are standard tests that tell us about the function and structure of the anal canal and lower rectum. The anorectal physiology examination measures the strength of the anal sphincter muscle and this involves inserting a probe into the anal canal. The next part of the test involves passing a balloon into the rectum attached to a piece of fine tubing to assess the sensation or feeling in the bowel. The ultrasound part of the test looks at the structure of the anal sphincter muscles and the lower rectum. It requires the physiologist to insert the ultrasound probe into the anal canal.