How to Diagnose Urinary Incontinence

Urinary incontinence is common in the US but it often goes undiagnosed.

One study conducted by Kaiser Permanente Northwest of 875 women concluded that 53% had undiagnosed urinary incontinence. While women are currently the largest-studied group when it comes to undiagnosed incontinence, there may be children, teens, and other adults unaware of their condition.

If you’re a nurse or provider looking to help people living with unacknowledged bladder problems, use this article as a resource. We’ll educate you about urinary incontinence and give you tips from board-certified Pediatric Nurse Practitioner, Samantha Eaker, and Susie Grosnki, licensed Doctor of Physical Therapy and certified Pelvic Rehabilitation Practitioner. Plus, you’ll find out how to get your patients free bladder control products!

• Medical conditions, like spina bifida, Parkinson’s disease, Alzheimer’s disease, etc.

• Disabilities, such as autism, Down syndrome, etc.

UI can affect people of any age or gender. With the proper care, UI can be treated or reversed in most cases.

Use the following guide from Samantha Eaker when discussing, diagnosing, and treating UI in children and teens.

Attempt to normalize the topic of UI when introducing it in a conversation with the patient or caregivers. Eaker recommends using phrases like:

• “It can be common for teens to have issues holding their pee or leaking urine during the day. Do you ever experience this? Are you able to stay completely dry during the day between bathroom breaks?”
• “Sometimes, kids pee on themselves during the day such as when they are distracted playing, or cannot get to the bathroom in time. Does this happen to you?”
• "Many parents have concerns that their child has daytime pee accidents, or their underwear seems wet with pee. Do you have any concerns about this with your child?”

There are many questionnaires used to gather information about UI and symptoms associated with the condition. Patients with UI might sometimes be more comfortable filling out a questionnaire and reviewing it with you to start the conversation. You can use our example questionnaire for diagnosing incontinence in your pediatric patients.

A few tests may be useful when attempting to diagnose UI in your patient. *See tests listed below.

A UI diagnosis is mainly based off clinical presentation coupled with positive reports of urinary leakage. “I would diagnose UI if the patient answers the first question from the questionnaire affirmatively (that they pee in their underwear OR into an incontinence product) if they’re around 4-5 years or older,” Eaker says.

It’s important to note that some literature suggests a younger age cut off for girls compared to boys when diagnosing UI. It can also be argued that UI can be diagnosed younger if your patient was previously continent for 6 months straight or longer. Some patients also have an accident once in a blue moon (1x a month, a few times a year), which isn’t uncommon and not necessarily abnormal. If your patient answers the first question with “Yes, but less frequently than the options provided,” you should inquire further to determine frequency of UI.

Treatment you provide to your patient is contingent on the type of UI they have (SUI, mixed incontinence, urge incontinence, etc.). Treatment is also contingent on how comfortable you and other providers at your clinic are in diagnosing, identifying, and treating UI.

Eaker suggests the following treatments for children and teens diagnosed with UI:

• Referral to a Specialist. Giving your patient a referral to see a specialist, such as a urologist, is never a bad idea, says Eaker. 

• Medical Therapy. Medical therapy may be applicable in some instances. Therapies may include:
  • Anticholinergics that help relax the bladder’s smooth muscle, increasing bladder capacity and decreasing overactivity which can cause spasms and subsequent incontinence episodes

     

  • Other medications used for UI in children or teens, such as Mirabegron (Myrbetriq)

• Biofeedback & Pelvic Floor Physical Therapy (PFPT). You can perform biofeedback treatment or suggest PFPT with a specialist like a urologist. 

There are other treatment modalities that may be indicated if UI is refractory to the above, such as:

• Electrical stimulation
• Posterior tibial nerve stimulation
• Botox injections
• Interstim and other surgical procedures

Use the following tips from Susie Gronski when discussing, diagnosing, and treating UI in adults.

Before discussing UI, ensure that you're speaking to your patient in a private space where they feel comfortable discussing sensitive topics.

“Use language that is empathetic, non-judgmental, and easy to understand,” says Gronski. “And avoid using medical jargon or technical terms that may confuse or intimidate your patient.”

Let your patient know that UI is a common condition that affects many people, and that there are many conservative options to treat it. You may also share statistics, like, “1 in every 3 women experience urinary incontinence,” to reinforce that they are not alone.

As mentioned above, some patients may feel more comfortable filling out a questionnaire before delving into the subject of UI. You can give them a questionnaire like the one we’ve provided for adults and review it with your patient during their visit.

The type of treatment you suggest to your patient may vary based on which type of UI they have, but treatments may include:

• Pelvic Floor Therapy. According to Gronski, pelvic floor occupational or physical therapy is the first line of defense when treating adult patients with UI.
• Educate Your Patient. “Knowledge is power,” Gronski says. She suggests educating and empowering patients by sharing resources, such as this short book called Understanding and Treating Incontinence.
• Lifestyle Factors. Discuss modifiable lifestyle factors such as smoking and diabetes to treat incontinence.
• Behavioral Strategies. Discuss behavioral strategies such as reducing bladder irritants like alcohol and caffeine or any other triggers identified in bladder diary.

Mid-stream Urine Sample: Taken from the patent and then analyzed with a dipstick test and under a microscope. A dipstick test is a strip of plastic that has several chemical pads which is then dipped into the urine sample and the pads change color according to the concentration of various substances such as glucose, protein, ketones, and blood in the urine.

Urine Culture: Checks for the presence of bacteria and other microorganisms in the urine. A urine culture is performed by first taking a mid-stream urine sample from the patient. Then, the sample is placed on a special culture plate that will allow bacterial growth to occur. The sample is placed in an incubator for 24-48 hours. The culture plate is then examined under a microscope to identify the type of bacteria in the sample.

Bladder Ultrasound: Non-invasive imaging test that uses high-frequency sound waves to create images of the bladder and surrounding organs. It is commonly used to evaluate the structure and function of the bladder and to diagnose various urinary tract conditions. It is also used to do a post void residual test to see how much urine is left over in your bladder after you just emptied it.

During a bladder ultrasound, the patient lies down on an examination table with their lower abdomen exposed. The provider or technician applies a small amount of gel to the skin of the lower abdomen to help transmit the sound waves. The gel may feel cool or wet, but it is harmless and will be wiped off after the procedure.

The provider then uses a handheld device called a transducer that emits high-frequency sound waves. The transducer is placed on the skin of the lower abdomen and moved around to capture images of the bladder and surrounding organs. Images of the bladder and surrounding organs are displayed on a computer monitor. The results are interpreted and shared with you by your doctor.

Renal Ultrasound: A renal ultrasound may be indicated to evaluate for any structural or anatomical abnormalities that could contribute to or cause UI.

Cystoscopy: Involves inserting a thin, flexible tube with a camera and light at the end, called a cystoscope, that travels within the urethra and then into bladder to examine the bladder and urinary tract for any structural abnormalities or blockages that may be contributing to the UI.

During a cystoscopy, the patient is positioned on an examination table and given a local anesthetic to numb the urethra. The provider then inserts the cystoscope into the urethra and slowly advances it up into the bladder. As the cystoscope is advanced, sterile fluid is often instilled into the bladder to expand it and improve visualization.

The provider uses the camera and light at the end of the cystoscope to inspect the lining of the bladder and urethra for any abnormalities, such as enlarged prostatic tissue causing urinary flow obstruction, urethral strictures, inflammation, tumors, or stones.

Urodynamic Test: Series of tests that evaluates how well the bladder, sphincters, and urethra are storing and releasing urine. These tests help to diagnose conditions that affect the urinary tract, such as urinary incontinence, overactive bladder, and bladder outlet obstruction. There are several tests that may be included as part of assessing urodynamics. Some tests that may be included as part of the urodynamic test include:

Uroflowmetry: Assesses the urine flow rate, the amount of urine volume urinated, and the time it takes to empty the bladder. The patient is asked to urinate into a special toilet or urinal that measures the flow rate and volume of urine. This test helps to evaluate the strength and coordination of the bladder muscles and urethral sphincters.

Pressure Flow Study: Assess at what bladder pressure a person feels the urge to urinate and how well they urinate at that pressure. A catheter is inserted into the bladder and a sterile solution is used to fill the bladder. When the patient senses the urge to urinate, they are asked to then urinate while a catheter is still inserted. A computer is connected to the catheter and measures the pressure in the bladder and urethra during urination to evaluate how well the bladder and urethra are working together.

Bladder Diary: A record of the patient's urinary habits, fluid intake and type, how often they urinate, how much they urinate (counting in seconds or measuring in ounces or milliliters), and whether they experience any leakage. This information is helpful to identify patterns and potential triggers for the patient's UI.

UI can sometimes require the use of incontinence products, but these supplies can be costly out of pocket, leaving your patients without proper treatment. The good news is that your pediatric and adult patients may qualify for free incontinence products, like bladder control pads, diapers, protective underwear, and more with Aeroflow Urology!

We take pride in making it easy for providers, nurses, and patients to obtain the best incontinence products at no cost through insurance. We’ll determine your patients’ eligibility through our online portal within 1-2 business days after they submit their information. We send free supply samples until your patient finds the product that suits their unique needs, and we ship their products at no cost directly to their home on a monthly basis.

We know that as a nurse or provider, you’re always going the extra mile for your patients, and telling them about Aeroflow Urology’s services is one more way to get them the care they need and deserve!

Your patients can fill out our secure Eligibility Form or visit aeroflowurology.com/qualify-through-insurance

References

Saks, E. K., & Arya, L. A. (2009). Pharmacologic Management of Urinary Incontinence, Voiding Dysfunction, and Overactive Bladder. Obstetrics and Gynecology Clinics of North America, 36(3), 493–507. https://doi.org/10.1016/j.ogc.2009.08.001 

vWallner, L. P., Porten, S., Meenan, R. T., O’Keefe Rosetti, M. C., Calhoun, E. A., Sarma, A. V., & Clemens, J. Q. (2009). Prevalence and Severity of Undiagnosed Urinary Incontinence in Women. The American Journal of Medicine, 122(11), 1037–1042. https://doi.org/10.1016/j.amjmed.2009.05.016 

Disclaimer

Information provided on the Aeroflow Urology website is not intended as a substitute to medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.