How assessment works

Who to see

You can start with a family doctor (general practitioner) at your local clinic or with a gynaecologist. They will do the initial assessment and start first-line treatment. You'll be referred to a urologist or urogynaecologist if there are warning signs, unusual symptoms, or if first-line treatment hasn't helped.

Talking to the doctor

This is the most important part of the assessment. The doctor will ask:

• when and in which situations you leak, and how much;
• how often you pass urine during the day and night, and whether you get sudden strong urges;
• whether you have pain, burning, blood in the urine, a feeling of incomplete emptying or a weak stream;
• how many pregnancies and births you've had, how they went and your babies' weights;
• what operations you've had, especially pelvic surgery;
• what long-term conditions you have (diabetes, lung or neurological conditions) and what medicines you take;
• how symptoms affect your work, sleep, relationships and exercise — and what you'd like treatment to achieve.

Feel free to answer in detail: for a doctor these are ordinary medical questions. It helps to take the ICIQ-SF test beforehand and bring the printout.

The bladder diary

A diary is a simple but very informative tool. International guidelines recommend keeping it for at least 3 days, including both working days and days off, to capture your usual routine.

Each time, write down:

• the time and approximate volume of each void (a measuring jug makes this easy);
• what and how much you drank;
• leaks: when, in what circumstances, how much;
• sudden strong urges;
• pad changes.

From the diary, the doctor can see how much you drink, how much your bladder holds, how much urine you produce at night and which type of incontinence is dominant. Often the diary itself points to a solution: for example, that you're drinking too little, or too much coffee.

Examination

The doctor examines your abdomen and usually does a vaginal examination. They check the vaginal lining (it can become thinner after menopause), look for prolapse, and may ask you to cough with a full bladder — a cough test that shows stress incontinence. They may also assess your pelvic floor strength by asking you to squeeze — and you'll find out whether you're doing the exercises correctly.

Tests

• Urine test (often a dipstick) — to rule out infection, blood or sugar in the urine. An infection can cause or worsen incontinence.
• Residual urine — how much urine stays in the bladder after you void. It's measured with ultrasound if there are signs of poor emptying or frequent infections.
• Blood test (for example, blood sugar) — if diabetes or kidney problems are suspected.

When further tests are needed

Urodynamic testing (measuring bladder pressure as it fills and empties), cystoscopy and other complex tests aren't needed by everyone. A specialist usually orders them if:

• surgery is being considered;
• the type of incontinence is unclear or symptoms are unusual;
• first-line treatment hasn't worked;
• you've had pelvic surgery or previous surgery for incontinence;
• there's a neurological condition, signs of poor bladder emptying or blood in the urine.

How to prepare for your appointment

1. Complete a 3-day bladder diary.
2. Take the ICIQ-SF test and print the result.
3. Make a list of all your medicines, including vitamins and herbal remedies.
4. Bring records of previous tests and operations.
5. Write down 2–3 key questions and your goal: for example, "I want to get back to running" or "I don't want to get up at night".

Sources

1. NICE guideline NG123. 2019. nice.org.uk
2. EAU Guidelines on Non-neurogenic Female LUTS. uroweb.org
3. Avery K, et al. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–330.