HOW CAN THE DOCTOR TELL WHICH TYPE OF INCONTINENCE YOU HAVE?

Incontinence is usually evaluated by a doctor with a special interest in this problem, usually either a gynecologist, urologist or urogynecologist (see chapter 13). The first part of figuring out what kind of incontinence you have should be a discussion with your doctor about exactly what causes you to lose urine. Expect to be asked a lot of questions. Just put any sense of discomfort or embarrassment aside and answer as completely as you can. Your answers are part of the information the doctor needs to find the type of problem you have. It is a good idea to think carefully about these things even before you see the doctor. Some doctors may send you a questionnaire before your appointment so that you are in the office with all the information at hand. The questions your doctor might ask are probably among those questions we’ve written here. It might help if you go through these questions and bring the answers with you when you visit your doctor.

What activities cause you to leak?

Loss of urine with laughing, coughing, sneezing often indicates stress incontinence. Loss of urine when you change position or when you put your hands in water often indicates urge incontinence.

Is the amount of urine lost small, or do you flood?

Stress incontinence usually causes leakage of a small amount of urine, while urgency incontinence can cause the loss of a lot of urine.

Do you wear pantiliners, pads or adult diapers to protect your clothes from wetting?

Your answer tells the doctor the severity of the problem.

Do you have an urge to urinate before you lose any urine?

A strong urge to go, followed by a loss of urine is usually a sign of urge incontinence. With stress incontinence, you do not feel any urge.

Do you lose urine before you get to the bathroom?

This is usually associated with an uncontrollable urge to go and indicates urgency incontinence.

Do these urges only occur with a full bladder?

If incontinence only happens with a full bladder, perhaps you are drinking too much or not going to the bathroom frequently enough.

How often do you urinate during the day? During the night?

Most people urinate about six times a day and once at night. An over-active bladder may lead to urgency and make you feel like you have to urinate more frequently.

Does your bladder feel empty after you urinate?

Scarring of the urethra may prevent you from emptying your bladder. An overactive bladder feels irritated much of the time and may never feel empty.

Is there pain or burning when you urinate?

These are often signs of a bladder infection.

Do you get more than one or two bladder infections a year?

Chronic or recurrent infections can cause long-lasting problems with the bladder.

Do you have any difficulty starting a stream of urine?

This might indicate a blockage in the urethra or a problem with the nerves leading to the bladder.

Do you have any trouble stopping the flow of urine once it starts?

Urgency incontinence can cause this symptom.

Do you feel any bulging from the vagina?

As a result of weakened pelvic tissue, the bladder may bulge down(cystocele) or the rectum may bulge up (rectocele) in the vagina. You may feel pressure in the vagina from this or may even feel the bulging at the opening of the vagina.

Do you feel a pulling or pressure in the pelvis, especially when you are on your feet for any length of time?

This symptom may indicate prolapse.

Do you leak constantly?

Both intrinsic sphincter deficiency (ISD) or overflow incontinence can cause this symptom (see pages XX).

Do you have any neurological problems, especially of the lower back or legs?

A severe injury to your back, a stroke, Parkinson’s disease or multiple sclerosis may interfere with the function of your bladder.

Do you have diabetes?

Diabetes can cause damage to the nerves going to the bladder, which may cause the bladder to not work as well as it should.

Have you had previous bladder surgery?

Surgery may have caused scar tissue that can interfere with the proper closure of the urethra.

The answers to these questions begin to give us an idea of what type of incontinence you might have. Think carefully about the questions, and bring the answers to your doctor. The next step in fixing the problem is a physical examination.

• WHAT CAN THE DOCTOR TELL FROM AN EXAMINATION?
• WHAT ARE THE Q-TIP TEST, STRESS TEST AND ULTRASOUND EVALUATION?
• WHAT IS A VOIDING DIARY?
• WHAT IS A PAD COUNT?
• WHAT IS URODYNAMICS TESTING?
• IS URODYNAMIC TESTING (UDS) NECESSARY?
• WHAT IS VIDEO URODYNAMIC TESTING?
• WHAT IS CYSTOSCOPY?
• WHAT IS AN IVP?

Edited Excerpts from our book
The Incontinence Solution

By William H. Parker, MD, Amy E. Rosenman, MD, and Rachel Parker

Order The Incontinence Solution directly from Amazon.com.

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