Tests and Examination for the Diagnosis of Urine Leakage in Women

There may be different reasons for urinary leakage in women. First of all, it is aimed to identify the underlying or contributing causes of the type of incontinence detected in the past. Diagnosis and diagnosis methods, which start with a physical examination, are as follows;

Physical Examination

The following information is obtained from the patient during the physical examination;
o General health status of the patient, especially impaired mental status (i.e. confusion, signs of dementia), obesity, and an assessment of seeking reduced mobility/hand dexterity abdominal examination (suggests possible urinary retention)
o Cough stress test (if stress incontinence is present)
o Pelvic examination; Perineum and external genitalia check for tissue health, signs of estrogen deficiency, vaginal examination with speculum for pelvic organ prolapse, bimanual pelvic and anorectal examination for pelvic masses and pelvic floor muscle function and tone

For Stress Incontinence Cough Test

Stress urinary incontinence in women should ideally be confirmed by examination.

During the first cough, the external urethral hole should be observed. The absence of leakage does not eliminate stress-type urinary incontinence.

Pelvic Examination

Using Bivalve and Sims specula, a visual and digital examination of the vagina should be performed to evaluate for masses, structural abnormalities, and evidence of pelvic organ prolapse. During the digital examination, it should be checked whether a soft, sensitive mass can be felt on the anterior vaginal wall, and whether there is urethral discharge or tenderness that may indicate a urethral diverticulum.
The pelvic floor musculature of the patient should be evaluated as ideal. A single finger is inserted into the vagina and the patient is asked to stretch the pelvic floor muscles, so that both strength and endurance of muscle tone should be evaluated. This can provide a basis for measuring the effectiveness of treatment. If a specialist is going to start pelvic floor muscle exercises while awaiting referral to a physiotherapist or nurse, it is useful to ensure that the patient is contracting the correct muscles.

Additional Examination

Further examination may be performed as indicated by the patient’s symptoms and signs.

Serum creatinine is usually not required, but may be considered if the patient has recurrent UTIs, urinary retention or renal obstruction is suspected. should document how often they ejaculate, any urgency events, any incontinence events, and pad/clothing changes. A bladder diary has been shown to be a reliable method for measuring frequency, incontinence, and response to therapy. four to eight times a day. Further testing (below) may be required after the bladder diary is completed at the follow-up consultation. Some of these tests may need to be performed in a secondary care setting.

Measurement of post-void residual bladder volume
Patients with recurrent UTI, symptomatic pelvic organ prolapse, or bladder distension with significant urinary incontinence symptoms should be evaluated in patients.Outflow catheterization can then also be used to measure the residual urine volume in the bladder, but should only be considered when bladder screening is not possible or urinary retention is recorded during the examination.

Urodynamic testing
Second-line urodynamic testing available. The urodynamic test measures how well the bladder and urethra store and release urine. The test usually records flow rate, residual urine, capacity and can identify involuntary spasm before, during or after voiding that is causing leakage. Buffer test, Q-tip test, Bonney and Fluid-Bridge tests are not recommended to evaluate urinary incontinence.

Pelvic organ prolapse
Pelvic organ prolapse is a common cause of urinary incontinence. It usually occurs following pelvic floor injury during childbirth, but may be multifactorial; It may result from loss of support from the vagina, pelvic floor muscles, and connective tissue, as well as from damage to the associated neurological system.
Conventional terms describing pelvic organ prolapse (eg.This is because the older terms imply a level of certainty about the structures that cause vaginal swelling, especially in women who have had previous pelvic organ prolapse surgery. The use of current practice is the terminology that divides the anterior pelvis into posterior and middle or apical compartments. These terms refer to:
o Anterior: The anterior wall of the vagina is herniated inward, usually due to the slipped position of the bladder and/or urethra and pressure on the vaginal wall. This term includes the possibility of a cystocele, urethrochoel, and cystourethrocele. This term includes the possibility of a rectocoel or enterocoel.
o Apical: The tissue that supports the uterus weakens and the uterus slides downward, putting pressure on the vagina; often associated with trauma at birthReferral to a Gynecologist or Urologist will likely be necessary for further evaluation and treatment.

Source:
https://www.webmd.com/urinary-incontinence- oab/doctors-test-urinary-incontinence-women
https://nyulangone.org/conditions/female-urinary-incontinence/diagnosis