Overactive Bladder Diagnosis

Diagnosis of overactive bladder is step one to finding the right treatment for it. Here are some of the tests that will be considered if you visit Metropolitan Urological Specialists. They serve patients in St. Louis, Creve Coeur, Florissant, and Kirkwood, Missouri.

A complete health history, including a voiding diary; a physical assessment; and one or more diagnostic procedures can help your health care provider diagnose any underlying condition and devise a suitable treatment plan for overactive bladder.

Medical History

The medical history includes information regarding bowel habits, patterns of urination and leakage (when, how often, how severe), and whether there is pain, discomfort, or straining when voiding. A history of health complications, pelvic surgeries, pregnancies, and list of medications (prescription and over-the-counter) also can supply information relevant to creating a diagnosis. In seniors, a mental status evaluation and evaluation of social and environmental factors also may be performed.

Physical Examination

A physical examination includes a neurologic status evaluation and examination of the abdomen, rectum, genitals, and pelvic area. The cough stress test, where the patient coughs forcefully while the physician observes the urethra, enables observation of urine loss. Immediate leakage with coughing indicates a diagnosis of stress incontinence. Leakage which is delayed or persistent after the cough indicates urge incontinence.

The physical examination also helps the physician identify health problems which can be the cause of overactive bladder. For example, poor reflexes or sensory responses may suggest a neurological disorder.

Urinalysis

Examination of the urine might identify health problems connected with overactive bladder, including the following:

•   Bacteriuria-presence of bacteria in urine; indicates infection
•   Glycosuria-excess glucose within urine; may indicate diabetes
•   Hematuria-blood in urine; may indicate kidney disease
•   Proteinuria-excess protein within urine; might point to kidney disease, cardiac disease, blood disease
•   Pyuria-presence of pus in urine; suggests infection

Specialized Testing

If overactive bladder continues on after diagnosis and treatment, further testing may be required. Urologists perform urodynamic, endoscopic, and imaging tests to obtain a more extensive evaluation of the lower urinary tract to figure out a new treatment plan.

Postvoid Residual Volume (PRV)

This procedure requires catheterization or pelvic ultrasound. The patient voids right before the PRV is measured. This initial void is observed for hesitancy, straining, or interrupted flow. A PRV lower than 50 mL indicates adequate bladder emptying. Recurring measurements of 100 to 200 mL or higher represent inadequate bladder emptying. The clinical setting and the individual's readiness to void might affect the test result; therefore, repeated measurements may be necessary.

Urodynamic Testing

Cystometry might be used to appraise the anatomic and functional status of the bladder and urethra. The cystometer is an instrument that measures the pressure and capacity of the bladder; thus evaluating the function of the detrusor muscle. Simple cystometry detects unusual detrusor compliance, but abdominal pressure isn't included and the results need to be evaluated with caution.

The multichannel, or subtracted, cystometrogram concurrently measures intra-abdominal, total bladder, and true detrusor pressures. This allows involuntary detrusor contractions to be differentiated from increased intra-abdominal pressure. The voiding cystometrogram registers outlet obstruction in patients who are able to void.

Uroflowmetry identifies unusual voiding patterns. Urethral pressure profilometry measures the resting and dynamic pressures within the urethra.

Endoscopic Tests

Cystoscopy may be carried out when urodynamic testing fails to duplicate symptoms, when the patient encounters new symptoms (e.g., cystitis, pain), or whenever urinalysis reveals a disease process (e.g., henaturia, pyuria). Cystoscopy identifies the presence of bladder lesions (e.g., cysts) and foreign bodies (e.g., stones).

Imaging Tests

X-rays and ultrasound can be used to evaluate anatomic conditions connected with overactive bladder. Imaging of the lower urinary tract before, during, and after voiding is useful in examining the anatomy of the urinary bladder and urethra.

If you think that you may have overactive bladder and want answers, visit Metropolitan Urological Specialists in St. Louis, MO and schedule an appointment.