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URINARY INCONTINENCE - DIAGNOSIS
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If the symptoms of urinary incontinence are already familiar to you – if you’ve changed your lifestyle to accommodate them, it is past time you made the effort to determine their cause.
 | | Don’t let embarrassment keep you from seeking out the professional medical advice you need. If you’re experiencing urinary incontinence, you are far from alone. Roughly thirteen million of us deal with urinary incontinence issues each year. Generally speaking, urinary incontinence is more prevalent in women than it is among men (10-30% of women compared to 1.5-5% of men). Incidences of the condition also increase with age. You see, urinary control depends on finely coordinated activity in the smooth muscle tissues of the bladder and urethra, skeletal muscles, and the autonomic nervous system – all of which break down with age. |
Urinary incontinence can also occur a result of other pathologic (disease) or congenital anatomic factors, which is to say that multiple sclerosis, ALS, spina bifida and other congenital and or acquired disorders related to muscle innervation typically result in inadequate urinary storage or control issues eventually.
Diagnostic Tests Used to Determine the Cause of Urinary Incontinence Include:
- Urinalysis: Chemical and or physical examination of the urine.
- Urine Culture: Test to check for urinary tract infection if indicated.
- Cystoscopy: An inspection of the inside of a patient’s bladder.
- Uroflow: A test that measure’s the pattern of urine flow.
- PVR Tests (Post Void Residual): Tests that measure the amount of urine left after urination.
- Urodynamic Studies: Tests that measure pressure and urine flow.
There are a variety of additional test’s that may be called for in order to rule out conditions such as pelvic weakness as the cause of a patient’s urinary incontinence. Pelvic examinations are necessary so that we could determine this.
URODYNAMICS
Diagnosing any occurrence or type of urologic voiding dysfunction, in men or women typically involves a relatively simple procedure known as urodynamics. The majority of urodynamic tests focus on the relative ability of a patient’s bladder's to empty completely and steadily. Urodynamic tests also work to demonstrate whether or not a given patient’s bladder is experiencing the kind of abnormal contractions that can result in urinary leakage.
Urodynamics testing answers an import set of questions–including whether or not a patient is experiencing difficulty when he or she is starting a urine stream, how much he or she has to strain in order to maintain a urine stream, whether or not that urine stream is interrupted during voiding, and whether or not there is urine is left in the patient’s bladder once he or he has finished urinating (post-void residual).
It’s no exaggeration to say that the umbrella of urodynamic testing ranges from straightforward observation to precise measurements taken with sophisticated instruments.
For instance, a uroflowmeter is used to automatically measure the amount of urine and its flow rate (meaning how quickly it flows out). Similarly, after a patient finishes urinating, he or she may still have a small amount of urine, an ounce or two or so, remaining in his or her bladder. In order to measure any post-void residual, it will be removed with a thin tube, or catheter, that can be guided gently into a patient’s urethra. In other cases, ultrasound equipment may be employed to offer a urologist a diagnostic picture of their patient’s bladder.
Cystometrogram (CMG)
CMG Tests May Be Used to Measure How Much Urine a Patient’s Bladder Can Hold
Occasionally, a CMG or cystometrogram will be used to obtain a precise measurement of exactly how much urine a given patient’s bladder is capable of holding, how much pressure builds up inside his or her bladder as it stores urine, and how full his or her bladder is when the urge or need to urinate presents itself. During a cystometrogram a doctor or nurse uses a catheter to completely empty a patient’s bladder. After that, a smaller, specialized catheter—fitted with a pressure sensitive tube known as a cystometer—will be used to slowly fill the patient’s bladder with warm water. A second catheter may be inserted into the patient’s rectum to record pressure there. Patients are then asked how their bladder feels and when they need to urinate and the water volume and bladder pressure will be recorded. Patient’s may be asked to strain or cough during the procedure so that any involuntary bladder contractions can be identified.
While a patient’s bladder is being filled for the cystometrogram, it may contract suddenly squeezing some water out without any warning. This simulates leakage and the cystometer will record the pressure at the stage when it occurred.
Such a reading can provide urologists with valuable information about the type of bladder problem a patient has. Patients will also be asked to attempt to exhale while holding their mouth and nose, cough, shift positions or otherwise apply abdominal pressure to their bladder so that the doctor or urologist can evaluate the action of their sphincter muscles.
Following the cystometrogram, patients are asked to empty their bladder so that the catheter can measure the pressure required to urinate. The pressure flow test will help identify bladder outlet obstructions that men experience in connection with an enlarged prostate (BPH). That type of bladder outlet obstruction is less common in women but may occur in cases involving a condition known as fallen bladder or following surgical procedures that combat urinary incontinence. Catheters can be used for both cystometrogram and pressure flow studies.
Electromyography Testing Measures the Muscle Activity of the Urethral Sphincter
Electromyography tests measure the muscle activity in a patient’s urethral sphincter by using sensors placed on the patient’s skin near their urethra and rectum. Occasionally the test sensors are fitted on a urethral or rectal catheter. The muscle activity of the patient is recorded using a specialized machine, and the impulses and patterns are recorded which tell doctors whether or not messages sent to the urethra and bladder are correctly coordinated.
Urodynamic testing can be performed with or without equipment in order to take pictures of a patient’s bladder during the filling and emptying process. The imaging equipment involved may make use of either x-rays or sound waves. If x-ray equipment is used, the liquid used to fill the bladder may be a contrast medium that will show up on the x-ray. The pictures and videos will show the shape and size of the patient’s urinary tract allow doctors to better understand their urinary problems.
To Learn More Urinary Incontinence or its , Please Dr. Kasabian
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Nabet G.Kasabian MD, FACS
103 East 80th Street (at Park Avenue)
New York, New York 10075
Tel: 212-535-0755; Fax: 212-744-4539 |
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