Diagnosing Female Urinary Incontinence

Urinary incontinence, a loss of bladder control, is common among women. Millions of women experience involuntary leakage of urine at some point in their lives. Some women have occasional, small leaks, but others lose a large amount. NYU Langone urologists and urogynecologists have extensive experience in diagnosing and treating urinary incontinence.

Certain lifestyle habits can contribute to urgency incontinence. These include excessive fluid intake and consuming alcohol and caffeine, which may irritate the bladder and increase your body’s production of urine. Other causes include certain medications, such as those prescribed for high blood pressure; antihistamines; antipsychotics; diuretics; muscle relaxants; opium-based painkillers; and sedatives. 

Urinary tract infections and constipation can also lead to urgency incontinence. Infections can irritate the bladder, and constipation can cause the bladder to become overactive, increasing your need to urinate. Urgency incontinence is also linked to neurologic conditions such as multiple sclerosis, Parkinson’s disease, stroke, and spinal cord injury. 

Stress incontinence has been associated with aging, childbirth, menopause, obesity, and pregnancy. These conditions can weaken pelvic floor muscles, the urethra, or both, allowing urine to leak during a cough, laugh, or sneeze, or when you’re lifting heavy objects. 

After taking a medical history and conducting a physical and pelvic exam, your NYU Langone doctor orders tests that may help diagnose female urinary incontinence.

Bladder Diary

Your doctor may ask you to keep a bladder diary, typically for three days. This is a record of the amount of liquid you drink, how often and how much you urinate, when you experience leaking or wetting, whether you felt an urge to go before any accidents, and what you were doing when the accidents happened.

Bladder Stress Test

If your doctor suspects you have stress incontinence, he or she may perform a simple bladder stress test. When you have a comfortably full bladder, your doctor asks you to cough and then checks for any involuntary loss of fluid. You may be asked to repeat the test while standing. 

Ultrasound

An ultrasound, in which sound waves create images that are viewed on a computer monitor, may be used to assess how well your bladder empties after urination.

Urinalysis

Your doctor may ask you to provide a urine sample so that he or she can analyze it for signs of a bladder or urinary tract infection, which can cause incontinence.

Urodynamics

Physicians may perform a group of tests, called urodynamics, which are used to assess bladder and urethral function. These can include tests that measure the volume and flow rate of urine, and check for urine leaks during coughing. 

Sometimes, doctors use video urodynamics, in which X-rays can help identify causes of urinary incontinence or problems with the bladder and urethra. During this test, performed in the doctor’s office, specialists fill the bladder with X-ray contrast material through a catheter in the urethra. They then take images of the bladder and urethra before and during urination, and while you are coughing. 

After the test, your doctor provides antibiotics to prevent infection that may be caused by catheterization.