Investigation Procedure for Urinary Incontinence

Urine Dip/Culture

This is an office test done to rule out the presence of infection. If the urine dip turns out to be positive then a culture is necessary to find out the organism and aantibacterial sensitivity. When women with urinary infection present with incontinence this is the first investigation that needs to be done.

Voiding Diary

It is essential to identify the voiding habits of women before treatment can be instituted. A voiding diary for 3 days gives us information about the quantity and type of fluid intake, urgency, leakage episodes and activity during leakage.

Bladder Scan

A bladder scan is usually done to see the volume of residual urine remaining in the bladder after a woman voids. A residual urine of more than 100ml usually indicates that there is a voiding problem.

Cystoscopy

This is usually done as an outpatient procedure under local anaesthesia. This entails looking inside the bladder using a small telescope. The procedure is painless and takes less than 5 min to complete. Bladder calculi, infection, stricture urethra, bladder muscle thickening and tumors are a few things that can be diagnosed by this procedure.

Urodynamics

Urodynamics is a bladder physiology study. It is probably the most important study that one can do in a patient with urinary incontinence. The study is done in a urodynamics lab in strict privacy. The patient is asked to lie on a couch in a recumbent position and her bladder is connected to a computer by catheters. The study is basically done to identify whether the patient has any obstruction to flow of urine, stable bladder and the pressure in the urethra. Many a time surgical decision making depends on urodynamic variables.

Investigation Procedure for Faecal Incontinence

Endoanal ultrasound(EAU)

This is done basically to identify the integrity of the anal sphincters. Tears, partial or complete in the sphincter mechanism can be made out. It is usually done with a 10 Mhz rotating probe.

Anorectal Manometry (ARM)

The ARM test is an essential component of any Anorectal physiology lab. Pressures in the External anal sphincter (EAS), Internal anal sphincter (IAS), Rectal compliance and Rectoanal inhibitory reflex can be detected by ARM.

Pudendal Nerve Terminal Motor Latency testing (PNTML)

The pudendal nerves are the main nerves supplying the pelvic floor including the sphincters. The motor latency tells us about the integrity of these nerves. When the latency period is prolonged we know that there is damage to the nerves and hence the outcome of sphincter repairs might not be very good.

Did You Know?
It is estimated that at least 11% of women in their lifetime will undergo surgery for pelvic organ prolapse or urinary incontinence and 30% of these might actually comeback for a resurgery.