Your Physical at the Urologist: What to Expect
No matter what one's medical condition may be, many people delay going to the doctor because they are afraid of "tests". Many people don't even know exactly of what they are afraid. In fact, I find that it is the not knowing that often keeps people away from having themselves treated. It is not unusual at the end of a visit with a patient, that he or she says to me either "that's it" or, "that wasn't so bad".
Below I have listed the basic physical examination you can expect to receive during a work-up for incontinence with a brief explanation of some of the tests and more specialized examinations. Please be aware that this is not necessarily a full list, or the list of every test that you will go through. Your doctor will decide what is most appropriate to diagnose what kind of incontinence you have. This is only a guideline to help make your visit seem less scary.
All visits start with a comprehensive history with a focus on your urinary system. Listed are some important pieces of information a doctor would like to know, and it may be helpful for you to take some notes beforehand.
- How many times a day do you leak urine, how severe, in what situations.
- How many pads a day do you go through, how wet are they, and what type (panty-liner, maxi-pads, adult diaper etc")
- How often do you get up at night
- How often during the day you have to urinate
- What do you typically drink in a day, especially coffee, tea, caffeine
As mentioned before, the physical exam and specialized tests are variable depending on the doctor's style and what he or she believes is the working diagnosis based on your history. Listed below are some examinations and some tests one may have at the Urologist's office.
- Pelvic Examination - Similar to what you would have at the Gynecologists office, but Urologists do not do Pap-smears. Can assess urethral hypermobility and pelvic floor strength.
- Post-void residual - done with a bladder scanner or catheter to see if you are emptying you bladder
- Uroflow - one urinates into a specialized toilet, and it can measure the strength of one's stream.
- Imaging Studies - some form of x-ray, either CT scan or other dye test to look at the urinary tract, plain X-ray to look at your bony skeleton for abnormalities, or ultrasound, if there is a history of blood in your urine or frequent infections.
Specialized tests: these are done to complete the work-up, and often aren't necessary for everyone.
- Urodynamics - basically this is a test that measures how strong your bladder squeezes, if it squeezes when it shouldn't, and at what pressure inside your bladder it takes to leak with cough etc. There are many different machines to perform this test, but all involve a temporary placement of a small catheter. It sounds much worse that is really is, and the information is important.
- Cystoscopy - a small camera telescope is placed into the bladder through the urethra and used to look for any abnormalities inside the bladder. Usually done in the office. This also falls into the category of "sound much worse than it really is".
I hope you find this helpful so you know what to expect. Again, this is not a list of every test you can expect, and your doctor may find you need testing that isn't on this list. This is meant as a guideline so make this visit more worthwhile, and less scary.