1. The Initial Assessment
When you see your doctor about your Lower Urinary Tract condition you will be given a physical and the doctor will take a short medical history to categorise which type of incontinence you may suffer from. Accordingly, they will direct treatment towards your predominant symptom, which is most often SUI.
- During the initial assessment they will attempt to identify other factors or diagnoses (any other existing illness) which will influence their suggested treatment of your condition. Depending on the severity of your condition, most doctors will recommend a conservative approach (pelvic floor exercises, drugs or non surgical laser treatment) first before offering a surgical alternative.
- Pelvic Floor Muscles: The doctor will perform a routine digital examination of the pelvic floor muscles to assess degree of muscle contraction before recommending pelvic floor muscle training to treat UI.
- Investigate Prolapse and refer women who have symptomatic prolapse that is visible or within the walls of the vagina, to a specialist.
- Urine testing:
- To detect presence of blood, glucose proteins and leucocytes and nitrites in the urine
- For Urinary Tract Infections (UTI)
2. Assessment Of Residual Urine
Information from a voiding diary can provide valuable information as part of the initial evaluation but is not used in isolation when diagnosing causes of Lower Urinary Tract Symptoms (LUTS).
The International Continence Society defines three types of diaries or charts to assist in recording voiding patterns and severity of symptoms.
- Micturition Time Chart records only the times that voids occur with no information on volume.
- Frequency/volume chart records the time and volume of each micturition (urination).
- Bladder Diary records the time and volume of each micturition and may also include other data such as incontinence episodes, pad usage, fluid intake and urgency. The ICS also recommends that voiding diaries be recorded over a period of at least 24 hours, but preferably a period of 3 -7 days is chosen. You’ll be encouraged to complete the diary covering variations in your usual activities such as both working and leisure days.
Findings from these diaries may include:
- Increased frequency but normal volumes suggesting a high fluid intake – possibly related to diabetes mellitus or diabetes insipidus but is more often a large intake born of habit.
- Reduced volume with little variation in voided amount possibly an indicator of bladder wall pathology such as carcinoma or interstitial cystitis
- Reduced volume with a variation in voided amount, possible detrusor muscle (bladder muscle) over activity
- Increased nocturnal production (Nocturia).
3. Bladder Scan
Often a bladder scan will be recommended to measure the amount of urine left in the bladder after voiding in women who have recurring UTI or having symptoms which suggest a dysfunction in voiding. A bladder scan is used in preference to catheterisation as it is more acceptable by the patient with a proven lower incidence of adverse events.
If the above testing does not provide the required information, your gynaecologist may suggest more complex urodynamic testing.