Urinary incontinence: what tests will your doctor do?

Author: Lou Wenjia Peking Union Medical College Hospital

Reviewer: Zhu Lan, Chief Physician, Professor, Doctoral Supervisor, Peking Union Medical College Hospital

Many female friends will suddenly "wet their pants" when they are at friends' parties, exercising, doing housework or working. In the long run, "wetting their pants" will make them smell like urine, feel embarrassed, and dare not go out.

Few people realize that "wetting your pants" - urinary incontinence - is actually a treatable condition and is not an inevitable result of aging, physical ageing or having children.

Therefore, women should learn about urinary incontinence, correct their wrong understanding of the disease, and seek medical treatment in time to improve their quality of life.

Figure 1 Copyright image, no permission to reprint

1. What is urinary incontinence?

Urinary incontinence refers to the involuntary leakage of urine caused by damage to the bladder sphincter or neurological dysfunction, which leads to a decrease or loss of urination control. Simply put, it means that adults cannot control the flow of urine through the urethra when they are in places where they should not urinate or when they cannot urinate.

Clinically, urinary incontinence is mainly divided into the following three types.

1. Stress urinary incontinence

When you sneeze, cough, exercise or work, involuntary urine leakage occurs due to increased abdominal pressure.

2. Urge urinary incontinence

When the patient feels a strong urge to urinate, urine cannot be controlled by the will ("cannot be held") and leaks out through the urethra.

3. Mixed urinary incontinence

In addition to stress incontinence, patients also have symptoms of urgency or urge incontinence. Mixed incontinence is sometimes dominated by stress incontinence and sometimes by urge incontinence.

According to statistics, among all adult female patients with urinary incontinence, about 60% suffer from stress urinary incontinence, 10% suffer from urge urinary incontinence, and 30% suffer from mixed urinary incontinence.

Figure 2 Copyright image, no permission to reprint

2. How to understand urinary incontinence

If urinary incontinence occurs, go to the hospital for examination as soon as possible. The doctor will first understand the medical history and then conduct a corresponding physical examination.

1. Detailed medical history

Before making a diagnosis, the doctor will first ask the patient some questions about urinary incontinence. For example, the patient's urine leakage frequency (such as how many times a day or a week), the amount of urine leakage (can be estimated by the weight of sanitary napkins or pads), under what circumstances does urinary incontinence usually occur, under what circumstances will improve or aggravate urinary incontinence, whether there is persistent urinary incontinence, or whether there is difficulty urinating, and whether urinary incontinence has occurred during sexual intercourse.

Secondly, the doctor will also ask the patient in detail whether he has other systemic diseases. For example, poor blood sugar control in diabetic patients can cause urinary incontinence; long-term chronic cough can also cause urinary incontinence. Therefore, the primary disease that causes urinary incontinence should be treated in time.

In addition, the doctor will also ask the patient about her gynecological and obstetric medical history, such as whether there is a history of prolonged normal labor, birth trauma, vacuum extraction, use of forceps, and delivery of a macrosomia.

In summary, patients should pay attention to their urinary incontinence and tell their doctors the truth about their condition, which will help doctors better assess their condition.

2. Physical examination

For most women, sometimes they are not sure whether they have other diseases. Therefore, the doctor will also perform a physical examination on the patient. During the physical examination, the doctor will pay attention to whether the patient has systemic diseases, such as whether there is a mass in the pelvis, whether there is pelvic organ prolapse and vaginal atrophy.

Figure 3 Copyright image, no permission to reprint

3. What tests are needed to diagnose urinary incontinence?

After the doctor understands the patient's medical history and performs a physical examination, the next step is to conduct an outpatient examination, which generally includes the following 7 items.

1. Pressure test

This is a pressure test after the bladder is empty. The procedure is as follows: the doctor asks the patient to lie on his back after urinating naturally, and then asks the patient to cough forcefully several times in a row when the bladder is empty. If urine leaks from the urethra at this time, the test result is positive.

2. Urinalysis and urine culture

Some patients present with urinary incontinence due to a urinary tract infection; therefore, urinalysis and urine culture are done to rule out urinary tract infection, hematuria, and metabolic abnormalities.

3. 1-hour urine pad test

It is a method to assess the severity of urinary incontinence. First, the patient is asked to wear a urine pad or sanitary napkin and perform a specified action within 1 hour. Then the weight of the urine pad or sanitary napkin is measured before and after the activity. The difference between the weight of the urine pad or sanitary napkin before and after the activity is the patient's urine leakage.

4. Urodynamic examination

The purpose of urodynamic examination is to measure various physiological indicators of bladder and urethral function during bladder filling and emptying. During the measurement process, a catheter needs to be inserted into the bladder and a pressure catheter needs to be placed in the vagina. The patient may feel a little uncomfortable.

5. Finger pressure test

When the pressure test is positive, a finger pressure test, also known as the bladder neck elevation test, is performed. How it works: The doctor inserts the index and middle fingers into the vagina, then spreads the fingers apart and places them on both sides of the posterior urethra, then pushes the bladder neck forward and upward, and asks the patient to cough continuously and forcefully to observe whether there is any urine leakage.

6. Cotton swab test

Doctors use this test to understand the condition of the patient's pelvic floor tissue. How to operate: The patient lies on a gynecological examination bed, and the doctor inserts a sterilized thin cotton swab into the appropriate position of the urethra. Then ask the patient to hold his breath, and measure the change in the angle between the cotton swab and the horizontal line before and after the patient holds his breath. If the angle is less than 30° and the patient also has symptoms of stress urinary incontinence, the doctor will do further examination.

7. Urinary diary

It is an important tool for assessing the daily condition of patients with urinary incontinence. Patients usually record it at home. It is necessary to record the urination situation for several days (usually 3 days), including the amount of water and beverages consumed, the time and amount of each urination, the time and number of urinary leakage, whether there is urinary urgency, frequent urination and nocturia, and the rest situation.

After completing the above examinations, the doctor can make a comprehensive consideration based on the severity of urinary incontinence and its impact on the patient and develop an appropriate treatment plan.

Conclusion

When facing "wetting your pants", female friends must not feel ashamed, or ignore it thinking it is a normal phenomenon. Once uncontrollable urinary incontinence occurs multiple times, you should seek medical attention in time and actively cooperate with the doctor's diagnosis and treatment, so that you can recover as soon as possible and improve your quality of life.

References

[1] Pang Haiyu, Zhu Lan, Xu Tao. Study on risk factors for urinary incontinence in Chinese women based on random forest algorithm[J]. Chinese Journal of Obstetrics and Gynecology, 2021, 56(8): 554-560.