Incontinence

Updated 01 April 2015

Diagnosing incontinence

Both urinary and faecal incontinence can be a symptom or sign of another health condition. For this reason, it is important identify the cause to correctly treat the incontinence.

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Anybody with a degree of incontinence that affects his or her lifestyle should see a health professional.

All but the most minor degrees of incontinence tend to be extremely inconvenient. Although incontinence per se isn't detrimental to the physical well-being of the patient, it impacts negatively on the social, sexual, recreational and working lives of people. The upside is that the majority of people with incontinence can either be cured or markedly improved.

Diagnosing urinary incontinence

Visit preparation
No specific preparation is necessary for the first visit. The health professional will want to check a urine sample, so it's best not to empty your bladder immediately prior to the visit.

The health professional will take a detailed history and perform a physical examination. The examination should include a vaginal and a rectal examination. Subsequent tests or procedures are usually scheduled for a mutually convenient time.

Diagnosis
The diagnosis of urinary incontinence is made based on a medical history, a physical examination and some confirmatory special tests. The health professional has to identify the type and severity of the incontinence, as well as the possible underlying cause(s).

History and examination
A careful history will often indicate the type of incontinence. The amount of protection (e.g. pads) required will give some indication of the severity of the problem. The voiding pattern is noted, and direct questions are asked regarding other urinary tract symptoms such as frequency or dysuria. Any concurrent or previous medical, surgical or obstetric history is noted.

The bladder is examined to see if it's full (overflow incontinence) or empty, and whether it's tender or not. A basic neurological examination is performed to rule out neurological causes for the incontinence. The underwear and pads are examined for evidence of wetness. The genital skin is inspected for evidence of urine-induced dermatitis. The urethra and vagina are examined next, usually with a speculum in place. The health professional specifically looks for atrophy of the tissues and for evidence of leaking with coughing (stress incontinence). An assessment is made of the integrity of the bladder and urethral support. A urine sample is tested for evidence of infection and blood.

Special tests
Which special tests are performed will depend on the findings of the history and the physical examination, and the suspected cause of the incontinence.

List and explanation of tests

Ultrasound scan: This uses very high-frequency sound waves to obtain images of the kidneys and bladder for evidence of obstruction and incomplete emptying.

Intravenous pyelogram (IVP): Contrast medium is injected into a vein and excreted by the kidneys. Serial X- rays are taken while the contrast passes through the urinary tract, demonstrating both the function and the anatomy of the system.

Micturatingcystourethrogram (MCUG): Contrast medium is inserted into the bladder and through a catheter X-rays are taken when the bladder is full and while the patient passes urine. The position and integrity of the bladder and the urethra are demonstrated.

Urodynamic study: This is a functional test of bladder muscle and bladder outlet function. Pressure probes are inserted into the bladder and the rectum. During the initial filling phase the bladder compliance, capacity and response to filling are measured. After capacity is reached, the patient is asked to pass urine and the pressure generated in the bladder as well as the bladder outlet resistance are measured.

Cystoscopy: This is the visual inspection of the inside of the urethra and bladder with a special instrument.

Diagnosing faecal incontinence

Identifying the exact causes of faecal incontinence (FI) will usually start with a doctor’s consultation and assessment, which includes a thorough medical history.

Your doctor is likely to ask about your symptoms, diet, medication, bowel habits and any other medical problems or factors that could affect bowel function. This information is important because FI can be linked to many other health conditions.

Your doctor may decide to refer you to a medical specialist for a physical examination and further tests. Once the test results and diagnosis are completed, you'll be informed about the most appropriate treatment. Even though you might find it awkward to discuss bowel problems, remember that many others are in the same situation.

It helps to know what type of questions the doctor may ask, so here are some of them:

- When did faecal incontinence start and how often does it occur?

- How much stool leakage occurs, does it just soil your underwear, is there only a small amount of solid or liquid stool that leaks out, or is there complete loss of bowel control?

- When you experience FI, do you have a strong urge to have a bowel movement or does it happen without warning?

- Do you have control over passing wind?

- How does faecal incontinence affect your daily life?

- Do you find the FI worsens after eating and are there certain foods that seem to make it worse?

TIP: Consider keeping a stool diary for a few weeks that records details of your daily bowel movements. This will make answering the doctor’s questions easier.

Read more:

Causes of incontinence

Treating incontinence

Preventing incontinence

Image: Drawing to show the pelvic floor muscles and their support of the uterus, bladder and rectum from Shutterstock

 

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Ask the Expert

Incontinence Expert

Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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