The first step for a physician to diagnose the cause of incontinence is to conduct a physical examination. Patients may be treated by a urologist (a physician specializing in the urinary tract) or a urogynecologist (a physician specializing in urological problems in women).

The physician will ask about the type of symptoms being experienced and review the patient’s medical history, including a list of current medications, past surgeries, pregnancy history and past illnesses. During a physical exam, the physician will look for signs of medical diseases or conditions that can cause incontinence. The examination can include looking for signs of pelvic floor abnormalities (e.g., types of prolapse or urethral abnormalities).

Patients may be asked to keep a bladder diary to record the times of urination and measure the amounts of urine produced. To measure urine, special containers that fit over the toilet rim are used. They can be purchased at drug stores or surgical supply stores.

Depending on the type and suspected cause of the incontinence, a physician may perform tests to determine the appropriate treatment. Some tests that may be performed include:

• Post-void residual measurement. Determines whether urine remains in the bladder after a patient has urinated. Measurements may be made by inserting a catheter (a small, soft tube) into the bladder to drain remaining urine or with an ultrasound, which uses sound waves to produce images of the body’s organs.
  
  
• Urinalysis. Laboratory analysis of a urine sample to determine the presence of infection, blood or other abnormalities in the urine.
  
  
• Ultrasound. An ultrasound may be performed to determine the size and shape of the kidneys and bladder and detect whether there are abnormalities that may cause incontinence.
  
  
• Cystoscopy. The physician places a cystoscope (a thin, tube with a tiny camera) inside the urethra to view the inside of the urethra and bladder.
  
  
• Urodynamic tests. Examine muscle function of the bladder and sphincter (the ring of muscles that surrounds the urethra). Urodynamics is a term to describe the study of how the body stores and releases urine. Using several urodynamic tests, the physician can determine whether bladder sensations and capacity are normal and whether the bladder fills and empties in a normal manner. An x-ray may be used to establish the degree of change in the position of the bladder and urethra during normal urination, coughing or sneezing.
  
  
• EEG (electroencephalogram) or EMG (electromyogram). Measuring nerve activity in the brain and lower abdomen may indicate a nervous condition contributing to incontinence.
  
  
• Blood test. Laboratory analysis of a sample of blood to test for the presence of various chemicals and substances related to the causes of incontinence.