An exact diagnosis is the prerequisite for effective treatment.
If the cause of urinary incontinence is not determined, treatment and care interventions cannot be successful either. The diagnosis must establish the type and causes of the existing urinary incontinence. The goal is to treat the patient not only symptomatically but also causally.
The persons affected themselves, the relatives caring for them or nursing staff caring for them can help establish the causes through the patients’ own observations or others’ observations which are communicated to the physician.
The diagnostic procedure is carried out by progressive stages:
• Anamnesis: The patient should bring his own observations and care anamneses to bear here. • General physical examination during basic diagnostics. • Special diagnosis: If the physician cannot make a clear diagnosis with the basic diagnostics or if conservative primary therapy failed, the diagnostic investigation should be expanded.
Anamnesis and basic diagnostics
During anamnesis the predisposing factors for urinary incontinence are ascertained. The physician should ask the patient about the following:
• Drugs to be taken (incontinence is often induced by drugs) • Menstrual cycle • Gynecological and urological diseases and operations • Sexual life • Defecation • Number of pregnancies (duration and type of deliveries) • Previously existing neurological diseases • Metabolic diseases such as diabetes mellitus
With the aid of a micturition diary the physician can obtain important information about drinking habits, micturition behavior, and the occurrence of incontinence. In the diary the patient notes the time of trips to the toilet, the micturition volume, and if necessary the occurrence of involuntary loss of urine over several days.
The clinical examination encompasses in women the inspection of external and internal genitals, in men the inspection and palpation of the penis.
The patient’s urine should be analyzed to rule out a urinary tract infection as a cause of urinary incontinence.
A patient’s urine loss per hour can be objectively quantified with the pad weigh test. The result is a decisive aid for the selection of a suitable incontinence aid and for the further therapeutic procedures.
The main objectives of the first examination of the patient are to search for morphological changes in the lower urinary tract by means of sonography and to determine the volume of residual urine.
Special diagnostics
If the physician cannot make a clear diagnosis with the basic diagnostics or if conservative primary therapy failed, the diagnostic investigation should be expanded.
The physician can employ the following diagnosis procedures for special diagnostics:
• Uroflowmetry – it measures the urinary flow rate per time period. • Urethral pressure profile measurement – it measures the function of the urethral closing mechanism at rest und under stress. • Cystometry – it records the pressure-volume relation of the urinary bladder. • Pelvic floor electromyography – for evaluation of the activity of the detrusor-sphincter dyssynergy.
During an expanded diagnostic investigation, the patient can also be examined radiologically (excretion urography, micturition cysto-urography) and endoscopically.
An exact urodynamic diagnosis should be made primarily before surgical procedures.
