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Fewer than half of the patients who have urinary incontinence tell their doctor about the problem. In many cases, patients simply feel that incontinence is part of aging. And, in spite of the commonness of this problem, two-thirds of doctors never ask their older patients if they experience incontinence.
It is important, however, for both the doctor and the patient to raise the issue. Although a third of American men and women age 30 - 70 have had at least some loss of bladder control, most have not been diagnosed by a doctor.
The first step in the diagnosis of incontinence is a detailed medical history. The doctor should ask questions about the patient's present and past medical conditions and patterns of urination. Patients should tell the doctor the following information:
- When the problem began
- Frequency of urination
- Amount of daily fluid intake
- Use of caffeine or alcohol
- Frequency and description of leakage or urine loss, including activity at the time, sensation of urge to urinate, and approximate volume of urine lost
- Frequency of urination during the night
- Whether the bladder feels empty after urinating
- Pain or burning during urination
- Problems starting or stopping the flow of urine
- Forcefulness of the urine stream
- Presence of blood, unusual odor or color in the urine
- A list of major surgeries with their dates, including pregnancies and deliveries, and other medical conditions
- Any medications being taken
Another method of diagnosing incontinence uses a test that asks 3 questions, which help a doctor distinguish between urge and stress urinary incontinence:
- During the last 3 months, have you leaked urine (even a small amount)?
- When did you leak urine? (During physical activity; when you could not reach the bathroom quickly enough; without physical activity or bladder urge.)
- When did you leak urine most often? (Physical activity; bladder urge; without or about equally with physical activity or bladder urge.)
Voiding Diary. The patient might find it helpful to keep a diary for 3 - 4 days before the office visit. This diary, sometimes referred to as a voiding diary or log, should be a detailed record of:
- Daily eating and drinking habits
- The times and amounts of normal urination
For each incident of incontinence, the log should also detail:
Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.