Incontinence, urinary - Diagnosing urinary incontinence

If you experience urinary incontinence, see your GP so they can determine the type of condition you have.

Try not to be embarrassed to speak to your GP about your incontinence. Urinary incontinence is a common problem and it's likely your GP has seen many people with the condition.

Your GP will ask you questions about your symptoms and medical history, including:

• whether the urinary incontinence occurs when you cough or laugh
• whether you need the toilet frequently during the day or night
• whether you have any difficulty passing urine when you go to the toilet 
• whether you are currently taking any medications
• how much fluid, alcohol or caffeine you drink 

Bladder diary

Your GP may suggest that you keep a diary of your bladder habits for at least three days, so you can give them as much information as possible about your condition. This should include details such as:

• how much fluid you drink
• the types of fluid you drink
• how often you need to pass urine
• the amount of urine you pass
• how many episodes of incontinence you experience 
• how many times you experience an urgent need to go to the toilet

Tests and examinations 

You may also need to have some tests and examinations so that your GP can confirm or rule out things that may be causing your incontinence. Some of these are explained below.

Physical examination

Your GP may examine you to assess the health of your urinary system.

If you are female, your GP will carry out a pelvic examination, which usually involves undressing from the waist down. You may be asked to cough to see if any urine leaks out.

Your GP may also examine your vagina. In over half of women with stress incontinence, part of the bladder may bulge into the vagina.

Your GP may place their finger inside your vagina and ask you to squeeze it with your pelvic floor muscles. These are the muscles that surround your bladder and urethra (the tube through which urine passes out of the body). Damage to your pelvic floor muscles can lead to urinary incontinence.

If you are male, your GP may check whether your prostate gland is enlarged. The prostate gland is located between the penis and bladder, and surrounds the urethra. If it is enlarged, it can cause symptoms of urinary incontinence, such as a frequent need to urinate.

You may also need a digital rectal examination to check the health of your prostate gland. This will involve your GP inserting their finger into your bottom. 

Dipstick test

If your GP thinks your symptoms may be caused by a urinary tract infection (UTI), a sample of your urine may be tested for bacteria. A small, chemically treated stick is dipped into your urine sample. It will change colour if bacteria are present. The dipstick test can also check the blood and protein levels in your urine.

Residual urine test

If your GP thinks you may have overflow incontinence, they may suggest a test called residual urine test to see how much urine is left in your bladder after you go for a wee.

This is usually done by carrying out an ultrasound scan of your bladder, although occasionally the amount of urine in your bladder may be measured after it has been drained using a catheter. This is a thin, flexible tube that is inserted into your urethra and passed through to your bladder.

Further tests

Some further tests may be necessary if the cause of your urinary incontinence is not clear. Your GP will usually start treating you first and may suggest these tests if treatment is not effective. 

Cystoscopy

A cystoscopy involves using a flexible viewing tube, known as an endoscope, to look inside your bladder and urinary system. This test can identify abnormalities that may be causing incontinence.

Urodynamic tests

These are a group of tests used to check the function of your bladder and urethra. This may include keeping a bladder diary for a few days (see above) and then attending an appointment at a hospital or clinic for tests such as:

• measuring the pressure in your bladder by inserting a catheter into your urethra
• measuring the pressure in your abdomen (tummy) by inserting a catheter into your bottom
• asking you to urinate into a special machine that measures the amount and flow of urine