U R S E R V I C E S
Incontinence: What You Can Expect At Your First Visit
Diagnosis Is The First Step In Treatment
If you have
a problem, make an appointment at the UCSF Women's Continence Center.
Incontinence is treatable, but most women do not seek help. Keep a diary
that includes how often you urinate during the day, a record of the times
and events surrounding leakage, and what you are drinking. This can help
your health care provider make the proper diagnosis and thus decide on
the appropriate treatment. At your first visit, your UCSF Women's Continence
Center provider will do a complete history and physical exam (including
a pelvic exam and urinalysis). If your problem is complex, additional
tests may be done at a later visit. Further details about what your provider
may ask or do are provided below.
below provides an overview of the types of questions your health care
provider may ask your during your initial office consultation. An overview
of some of the tests that may be conducted is also provided.
Assessment Information Your Provider May Collect
- A detailed
yet focused history about your past and present urinary difficulties.
medical history, especially with regards to urologic, gynecologic, or
- The medications
you use. Bringing
a complete list of your current medications is always helpful. As you
can see below, a wide variety of medications may have a side effect
on your urinary function so your doctor needs to know.
Diabetes medicines (Insulin, Glyburide®,
Drugs to treat depression (Wellbutrin®, Prozac®, Zoloft®, Paxil®, etc.)
Sedatives (Valium®, Ativan®, etc.)
Narcotics (Codeine®, Duragesic®, Vicodin®, MS Contin®, etc)
Many over-the-counter cold/flu and diet medications
Blood pressure medications
surgeries, especially urologic, gynecologic, or neurosurgical surgeries.
Information Your Provider May Collect
- The 3 Incontinence Questions: http://www.ucsf.edu/wcc/PatientSummary.pdf
- The duration
and characteristics of the urinary incontinence.
- The most
bothersome symptoms -- helps to guide therapy.
- The frequency,
timing, and amount of your voids and incontinent episodes.
- The events
that make you loose your urine.
about other lower urinary tract symptoms.
fluid intake pattern. Do you drink caffeine or alcohol?
about previous incontinence evaluations and treatments.
- The amount
and type of protections (pads, briefs, diapers) you use.
expectations for outcomes of treatment.
- An assessment
of your mobility, home, or other social factors.
- The severity
of leakage: lying, sitting or standing position
requirement: pads per day, wetness of pads
severe enough for you to consider surgery?
about any neurologic symptoms: weakness or numbness in legs, decreased
awareness of when your bladder is full, headaches, visual disturbances,
difficulties with walking or balance, or severe uncontrolled loss of
stool and/or flatus.
on the particular details of your medical history, your doctor may proceed
to any or all of the following physical evaluations.
EXAM: This will evaluate the strength, sensation, and reflexes
in your legs.
EXAMINATION: This will assess whether you have any pelvic relaxation
VOID RESIDUAL URINE ASSESSMENT: This is a simple assessment
to check how much urine remains in your bladder within 15 minutes of
voiding. It offers an estimation of your bladder's ability to efficiently
"empty the tank".
ASSESSMENTS: At the same time a postvoid residual is checked, the same
urine sample may be analyzed for other parameters, such as blood, sugar,
crystals, or signs of infection. Such an evaluation can be accomplished
with an office urine dipstick or the hospital laboratory's microscopic
CULTURE: If a urine dipstick or urinalysis suggests signs of
acute infection, a urine culture will be sent to the microbiology lab.
In approximately 24 to 48 hours, bacterial growth can be detected and
the specific strain identified.
FLOOR ASSESSMENT: As part of the pelvic examination, your provider will
evaluate the strength of your pelvic floor muscles, and particularly,
your own ability to contract and relax the appropriate muscle group.
STRESS TEST: This is a test whereby your doctor instills water into
your bladder, and then asks you to cough or strain in the same manner
that would cause you to leak urine in your daily life. This test can
be performed in the office or incorporated into more elaborate urodynamics
DIARY: Sometimes details about your fluid intake and urine
output are crucial to making the right diagnosis. Because this is not
typically the sort of information we take notice of in our daily lives,
your provider will give you a bladder diary, and a measuring receptacle.
You may be asked
to carefully record the time and amount of any fluids you drink and
the urine you void over a complete 24 hour period. You may be asked
to repeat this 24 hour diary for 3 to 5 days. This allows us to notice
patterns that might be important to planning your treatment.
clinical picture seems less straightforward, or multiple previous therapies
have been unsuccessful; your doctor may decide to pursue further diagnostic
testing. Below is a list of some clinical scenarios that are more complex
and merit further testing:
diagnosis for bladder problems
to develop successful treatment plan
(blood in urine) without infection
post-void residual urine volume
of these studies is to evaluate the anatomic and functional status of
the bladder and urethra, reproducing your symptoms. Testing may include
a cystometrogram, urethral pressure profile, and/or uroflowmetry
For this test, catheters are placed in your bladder and vagina
or rectum so that the physician can reproduce your daily urinary symptoms.
During the test, fluid will be infused in a controlled fashion to determine
various characteristics about your bladder's function, for example:
perception of water filling the bladder
urgency to urinate
uncontrollable bladder contractions
volume at which your bladder cannot comfortably hold any more
pressures that develop within your bladder during the fluid storage
TESTING: You may be asked to perform a number of maneuvers (such as
coughing, changing positions, or bouncing on your heel) with the catheter
in place in an effort to reproduce any symptoms of urine leakage or
PRESSURE PROFILE: For the test, the catheter in your urethra may be
to manipulated to measure your urethral function.
During urination, a specially devised receptacle will measure the
varying rate of urine flow, as well as duration of the urination process.
VOIDING STUDY: Your doctor may use this test to identify abnormal voiding
patterns or urine outflow obstruction
This slender fiberoptic instrument is inserted via the urethra
into the bladder. It enables your doctor to view the interior anatomy
of the bladder and urethra in great detail. It is typically an outpatient
diagnostic procedure performed for the following common symptoms:
(hematuria) or pus (pyuria) in urine with no bacteria present
infections which are unusually difficult to treat
onset irritative voiding symptoms
onset bladder pain
foreign body in the bladder
fail to duplicate incontinence symptoms
TESTS: Identify upper or lower urinary tract structural abnormalities
This test involves the administration of intravenous (IV) dye
to your bloodstream. The goal is to then obtain x-ray snapshots
of the entire urinary tract over the time period that the kidneys
are processing the injected dye from the bloodstream. This test
cannot be performed in those patients with a known allergic reaction
to IV contrast dye, or those with abnormal kidney function
scan of abdomen and pelvis
This is a test in which an x-ray machine takes a rapid sequence
of 2-dimensional thin cross-sections of the body in the area of
interest. This exam can be performed with or without contrast dye
in some clinical situations-mostly, this depends on what your doctor
is looking for. The x-ray pictures obtained provide great anatomic
detail of most of the internal organs.
Unlike the previous two tests, this one does not involve x-rays.
It utilizes a skin probe that directs sound waves to bounce off
the body's internal organs in order to produce an anatomic picture.
It can be a very useful screening tool for a number of the above
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