Urinary incontinence – what is it exactly?

The International Continence Society (ICS) defines urinary incontinence as every involuntary leakage of urine, i.e., when it is not (always) possible for patients to control the time and place of urination. Furthermore, the ICS differentiates several forms as outlined below.

Urinary incontinence - diagnosis

Since there are different forms of urinary incontinence, medical diagnosis is a basic requirement for successful therapy. Diagnostic tests investigate which form of bladder dysfunction the patient suffers from and what factors may be able to influence the disorder.

The majority of cases of bladder dysfunction can be diagnosed adequately by a thorough history alone and by simple tests. The diagnosis of bladder dysfunction is divided into basic diagnostic tests and further diagnostic tests.

Basic diagnosis can be made by any doctor. It includes the following measures:

Taking a history

The general history serves to find out the individual's drinking and urination habits, the previous medical history and co-existing diseases and treatments. Moreover, the patient’s habits also play a crucial role in drawing attention to possible risk factors. 

Completing a bladder questionnaire

A bladder questionnaire serves to identify the type and severity of bladder dysfunction. Depending on the answers, severity can be assessed and treatment options can be recommended. 

A bladder questionnaire serves to identify the type and severity of bladder dysfunction. Depending on the answers, severity can be assessed and treatment options can be recommended.

Compiling a bladder diary

A bladder diary is a record of fluid intake and urination made by the patient over 3 days that can help assess the severity and form of the bladder dysfunction. The patient records in detail the number of visits to the toilet, the voided volume, any incontinence episodes and the volume of liquid drunk. 

Thorough physical examination

The physical examination includes the following steps: examination of the abdomen, examination of the external genitalia, rectal examination, vaginal examination, cough test. The cough test examines whether the patient leaks urine under stress when the bladder is partially full.

Urine test

The urine test detects blood, protein and bacteria in the urine, as well as the pH, by means of test strips.

Ultrasound

In an ultrasound scan, the upper and lower urinary tract, especially the kidneys and ureters, are examined. In addition, the post-void residual urine after urination can be determined and the thickness of the bladder wall can be measured.

Further diagnostic tests are necessary only if the basic diagnosis yields evidence of possible complicating factors, or if all of the treatment measures based on the basic diagnostic tests are unsuccessful. Further diagnostic tests are performed by a specialist and include the following investigations:

  • Uroflowmetry
    Measurement of urine flow while the bladder is emptied.
  • X-ray
    With contrast agent to identify malformations or organ changes.
  • Urodynamics
    Checks bladder function by measuring bladder pressure and bladder volume.
  • Cystoscopy
    Examination of the urethra and bladder through an endoscope, usually performed as video urethrocystoscopy.
  • Supplementary neurological investigations
  • Additional neurological diagnostic tests if disorders of the central nervous system are suspected.

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