How is SUI Diagnosed?

How do I talk about SUI with my Healthcare Provider?

The first step in diagnosing SUI is to talk to your healthcare provider about your symptoms. If you think you have SUI, tell your provider about what's happening. That is the only way to know for sure and find relief. Start with a Primary Care provider who can often initiate treatment without sending you to a specialist. If needed, they can refer you to a urologist or gynecologist. These are doctors who have more experience with pelvic floor conditions like urinary incontinence. Some may have obtained additional certification in female pelvic medicine and reconstructive surgery (FPMRS).

If you don't feel comfortable talking about your symptoms, a little planning will make you more confident. Here are some tips to help begin a conversation with your provider to get help:

Be Prepared

Before your visit write down your experiences and questions and bring this with you. Your notes will help you remember what you want to say. Make lists of:

  • Your symptoms, how they affect you, and how often
  • Prescription drugs, over-the-counter-medicines, vitamins and/or herbs you take
  • Past and current illnesses, surgeries or injuries
  • Questions you want to ask

Bring up the Topic

If your healthcare provider doesn't ask you about SUI symptoms, bring up the topic. Don't wait until the end of your visit. Talk about it early on. That way there will be time for questions. If a nurse meets with you first, tell the nurse about your symptoms.

Speak Freely and Ask Questions

Tell your healthcare provider about your symptoms and feelings. Talk about how your life is affected. Your provider is used to hearing about all kinds of problems. It's okay to talk freely.

Some people find it helpful to use questions like these to help begin the conversation:

  • I am afraid to be too far from a bathroom or change of clothes because of leaking. What can I do to manage this problem better?
  • I've changed my daily habits because I am afraid of "accidents". What can I do to get my life back?
  • I have stopped exercising or playing sports because I leak urine. Can you help me get back to doing the things I enjoy?
  • I have become uncomfortable with myself and my body because I leak urine. What can I do to regain control? 
  • I avoid having sex because I am worried that I may leak. Please help me learn some strategies to help with this.

Talk About Next Steps

When you speak with someone who can address your concerns, it helps to write down what you want to ask in advance. Bring your list with you to your visit. You may also want to begin a bladder diary. The bladder diary is a tool to track urinary patterns. With it, you write down when you urinate and leak, what might trigger problems, and eating /drinking patterns for a few days. Bring the diary with you to your appointment. You and your healthcare provider will go over it together.

Next, your healthcare provider will begin an evaluation to learn what's causing the problem. Below are some things healthcare providers may do to find the cause of SUI:

Your Medical History

Your healthcare provider will ask about your symptoms, how long you've had them, and how they're affecting you. A medical history will include questions about:

  • Your past and present health 
  • The frequency, timing and severity of your symptoms
  • Pain or other symptoms (like bloating or constipation)
  • Your diet
  • How much and what kinds of liquids you drink daily
  • For women: your menopausal status and childbirth history Delete bullet
  • Your past surgeries (especially if you had pelvic surgeries)
  • Over-the-counter and prescription drugs you usually take

Your healthcare provider is there to help you, don't be embarrassed talking about this topic. Speak honestly. This information will guide the best way to treat your problem.

The Physical Exam

For women, your physical exam may include checking your abdomen, the organs in your pelvis, and your rectum. For men, a physical exam may include checking your genitalia and abdomen, prostate and rectum. Your healthcare provider may also test how strong your pelvic floor muscles and sphincter muscles are. You may be asked to squeeze your pelvic muscles and sphincter muscles for a Kegel test.

The physician may have you perform maneuvers such as coughing, straining down or stepping to see if these actions cause you to leak urine.

Bladder Diary

It is a good idea to start and keep a "bladder diary." This is a tool to track your day-to-day symptoms. In your diary, you will write down what fluids you drink and how often you go to the bathroom. You also need to note when you have leaks. Include what you were doing when the leak happened, such as running, coughing or sneezing.

The symptoms you share will help your provider understand what's happening so he/she can begin to diagnose and provide treatment for you.

Pad Test

There are two types of urinary pad tests: the one- hour test and the 24-hour test. The one-hour pad test is usually done in the office to learn about leakage with exercise or movement. The pad is removed and weighed afterwards to evaluate the amount of urine leaked. The 24-hour urine pad test is usually done at home for a complete day and night's evaluation. 

Other Testing

Sometimes the description of symptoms and physical exam do not provide enough information for an accurate diagnosis. When this is the case, you may be referred to a specialist for more comprehensive testing.

These specialized tests may be used for your diagnosis:

  • A urinalysis or urine sample to test for a urinary tract infection or blood in the urine. 
  • A bladder scan after urinating to show how much urine stays in your bladder after you urinate. 
  • A Cystoscopy uses a narrow tube with a tiny camera to see into the bladder to rule out more serious problems.
  • Urodynamic studies (UDS) are done to test how well the bladder, sphincters and urethra hold and release urine.

Once your provider understands the type of incontinence you have and rules out other conditions, he/she will offer you treatment options to feel better.