Incontinence - stress

• Coughing
• Sneezing
• Standing
• Exercising
• During other physical activity

A physical examination will include an abdominal and rectal exam, a genital exam in men, and a pelvic exam in women. In some women, a pelvic examination may detect cystocele or urethrocele (protrusion of the bladder or urethra into the vaginal space).

Patients may be asked to keep a urinary diary, recording how many times you urinate during the day and night, and how often urinary leaking occurs.

Tests may include:

• Post-void residual (PVR) to measure amount of urine left after urination
• Urinalysis or urine culture to rule out urinary tract infection
• Urinary stress test (the patient is asked to stand with a full bladder, and then cough)
• Pad test (after placement of a pre-weighed sanitary pad, the patient is asked to exercise -- following exercise, the pad is re-weighed to determine the amount of urine loss)
• A pelvic or abdominal ultrasound
• X-rays with contrast dye of the kidneys and bladder
• Cystoscopy (inspection of the inside of the bladder)
• Urodynamic studies (tests to measure pressure and urine flow)
• Rarely, an EMG (electromyogram) is performed to study muscle activity in the urethra or pelvic floor

Other tests may include the measurement of the change in the angle of the urethra when at rest and when straining (Q-tip test). An angle change of greater than 30 degrees often indicates significant weakness of the muscles and tissues that support the bladder.