kidney and urinary tract disorders
Urinary Incontinence in Adults
Evaluation of Urinary Incontinence
Urinary incontinence usually does not indicate a disorder that is life threatening; nevertheless, incontinence may cause embarrassment or lead people to restrict their activities unnecessarily, contributing to a decline in quality of life. Also, rarely, sudden incontinence can be a symptom of a spinal cord disorder. The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation. In people with urinary incontinence, certain symptoms and characteristics are cause for concern. They include Symptoms of spinal cord damage (for example, weakness in the legs or loss of sensation in the legs or around the genitals or anus) People with warning signs should go to an emergency department at once. People without warning signs should call their doctor. The doctor will decide how quickly they need to be seen based on their other symptoms and other known conditions. Most people are embarrassed to mention incontinence to their doctors. Some people believe that incontinence is a normal part of aging. However, incontinence, even incontinence that has been present for some time or that occurs in an older adult, may be helped by treatment. If symptoms of urinary incontinence are bothersome, interfere with activities of daily living, or cause people to curtail their social activities, people should see a doctor. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the incontinence and the tests that may need to be done. Doctors ask questions about the circumstances of urine loss, including amount, time of day, and any precipitating factors (such as coughing, sneezing, or straining). People are asked whether they can sense the need to urinate and, if so, whether the sensation is normal or comes with sudden urgency. Doctors may also ask the person to estimate the amount of urine leakage. Doctors will also ask whether the person has any additional problems with urination, such as pain or burning during urination, a frequent need to urinate, difficulty starting urination, or a weak urine stream. Sometimes doctors may ask people to keep a record of their urination habits over a day or two. This record is called a voiding diary. Each time the person urinates, the volume and time are recorded. After an episode of incontinence, the person also records any related activities, especially eating, drinking, medication use, or sleeping. Doctors ask about whether the person has other disorders that are known to cause incontinence, such as Dementia , The physical examination can help doctors narrow possible causes. Doctors test strength, sensation and reflexes in the legs, and sensation around the genitals and anus to detect nerve and muscle problems that may make it difficult for the person to remain continent. In women, doctors do a pelvic examination to detect abnormalities that could cause incontinence, such as Symptoms after menopause (menopausal changes in which the lining of the vagina becomes thinner, drier, and less elastic and may be accompanied by urinary tract changes) or Often findings during the physical examination can help doctors determine the cause or identify factors that contribute to incontinence. However, some tests are often needed so doctors can make a firm diagnosis. Routinely obtained tests include Urinalysis and Urine Culture None Kidney Function Tests and sometimes others Postvoid residual volume (a catheter or ultrasonography is used to determine how much urine is left in the bladder after a person urinates) Sometimes urodynamic testing Urodynamic testingincludes cystometry, urinary flow rate testing, and cystometrography and is done when clinical evaluation and the above tests do not reveal the cause of incontinence. Cystometry is done to confirm urge incontinence and to determine whether the cause is overactive bladder. A bladder catheter is placed through the urethra. A doctor measures how much water can be injected into the bladder until the person develops a sense of urgency or bladder contractions. Peak urinary flow rate is measured in men to determine whether incontinence is caused by bladder outlet obstruction (usually caused by Benign Prostatic Hyperplasia (BPH) ). Men urinate into a special device (uroflowmeter) that measures the speed of urine flow and how much urine is released. Cystometrography is done if all other evaluation fails to reveal the cause of incontinence. Cystometrography is a test that measures bladder pressures when the bladder is filled with various volumes of water. Cystometrography is often done with Electromyography , a test that can assess sphincter function. In certain centers with specialized equipment, bladder contraction strength can also be measured at the same time as sphincter and other bladder pressures. Although urodynamic testing is important, results do not always predict response to medication or indicate the relative importance of multiple causes. 