With increasing suffering pressure, the visit to the competent doctor helps. This performs a comprehensive examination to clarify the causes of urinary incontinence. If necessary, a referral to a specialist is then made.
Which doctor is responsible for urinary incontinence?
For an initial examination, a visit to the family doctor or, in the case of female sufferers, to the gynecologist is advisable. When urinary incontinence sufferers see a doctor, he or she will first take a history (anamnesis) of the bladder weakness in a consultation. This is followed by a physical examination to determine the causes. If necessary, the doctor will then carry out or arrange for further diagnostic measures. If necessary, referral to a continence and pelvic floor center, a specialized urologist or a urogynecologist will follow.
Detection and investigations for urinary incontinence.
During the doctor’s interview, the doctor will probably ask these questions:
- How long have you suffered from bladder weakness?
- How often do you lose urine without wanting to? How much urine do you lose?
- Does urine loss occur in certain situations, such as during physical exertion?
- Do you often feel a strong urge to urinate?
- How often during the day and night do you need to go to the toilet?
- Do you feel that you cannot empty your bladder completely?
- Do you have pain when urinating?
- Is the urine bloody?
- Have you had surgery in the time before the bladder weakness?
- Do you currently suffer from any other medical conditions?
- Do you take any medications on a regular basis? If yes, which ones?
The physical examination
After the anamnesis, the doctor makes an orienting picture through a general physical examination. This mainly includes palpation and delineation of the bladder and surrounding organs. In women, an assessment of the pelvic floor muscles is necessary, and in men, of the prostate. A urine sample is examined in the laboratory for bacteria, protein, red or white blood cells. If other conditions, such as cystitis, are present, they must be treated first. Bladder cancer should not be overlooked.
Ultrasound examination for urinary incontinence
Ultrasound examination (sonography) is a painless and side-effect-free examination technique that has become routine and is used to visualize internal organs on a monitor. Here, the location of the kidney and the draining urinary tract, findings such as kidney or bladder stones, tumors or congenital malformations can be determined. The emptying function of the bladder can also be easily checked with the help of ultrasound. The image of the filled and then the emptied bladder provides information about the filling volume and about any residual urine; but also about the bladder contour, including any irregularities (bladder cancer). An examination of the prostate is also readily available with an ultrasound examination through the rectum.
Urine flow measurement
During urine flow measurement, the patient empties his or her bladder into a measuring funnel or on a special toilet seat. Connected measuring devices record the amount of urine excreted per second and determine a urine flow curve. By the shape of this curve, the physician recognizes bladder emptying disorders or outflow obstructions caused by urethral strictures or prostate enlargements.
Bladder and sphincter function diagnostics (urodynamics).
By simultaneously measuring the pressure in the bladder via a bladder catheter and the flow of urine as a function of bladder filling, bladder activity and sphincter function can be measured and documented. This examination is essential when a clear distinction between stress and urge incontinence is not possible with simple clinical examinations or when surgery is planned.
X-ray examination
A contrast medium is required to visualize the kidneys, bladder, and urinary tract on x-ray. Depending on the question, this can be directed into the bloodstream via the veins, filled into the bladder via a catheter, or filled into the renal pelvis via the ureters. An x-ray examination is rarely necessary.
Cystoscopy for urinary incontinence.
A cystoscopy allows the bladder and prostate to be viewed from the inside through an endoscope inserted through the urethra.In this way, the doctor assesses the condition of the bladder mucosa (inflammation) and determines whether there are any stones, tumors or abnormalities. The decision on the necessity of such an examination should be made by a specialist (urologist); if bladder cancer is suspected, it is unavoidable.
