Diagnosis of Urinary Incontinence

Urodynamic diagnosis

The urodynamic examination consists of two stages. To begin with, the bladder is slowly filled with warm saline solution to test the function of the bladder with respect to the urge to urinate, filling capacity and stability. For this purpose, a pressure-measuring catheter is inserted into the bladder by way of the urethra so that changes in bladder pressure can be recorded. An urge to urinate will develop very quickly in individuals with a hypersensitive bladder resulting from a bladder infection or those patients who are used to going to the toilet frequently, and with a ‘dysfunctional’ bladder, this will often lead to a forceful urge to urinate and involuntary discharge of urine. Another example of a bladder dysfunction is impaired bladder function in individuals with diabetes. Here, there is no initial urge to urinate; voiding only takes place after distension of the bladder as an overflow mechanism. Consequently, much about the bladder’s function can be discerned from a first urodynamic exam. There is also a disorder of the bladder where involuntary muscle contractions of the bladder cause urinary incontinence; this is known as urge incontinence and can be treated with drugs. The second stage of the urodynamic examination measures the urethra’s closing mechanism, both in a relaxed state and under stress. In measuring the closing mechanism of the urethral sphincter a catheter is also used, which is slowly pulled back from the bladder into the urethra. The first measurement occurs during a relaxed state; the second during conditions of stress, such as coughing.

Introital ultrasound


Functional ultrasound of the bladder and its sphincter reveals the anatomical relationship of the bladder with surrounding organs. It shows the structure of the pelvic floor muscles and how the bladder’s closing mechanism changes under stress or during coughing. By placing the pelvic floor muscles under stress, one can establish whether they can be activated properly and thereby support the action of the urethral sphincter. If the muscles have been injured, e.g., after a difficult birth, corrective surgery may be required. Where the muscles are simply weak, training of the pelvic floor muscles is advisable, possibly including biofeedback.