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Home >> Men's Health >> Bladder Problems: Diagnosis
 Bladder Problems - Diagnosis
Overview | Diagnosis | Treatment | FAQ
Below are just a few common bladder / urinary problems and diagnostic information:
Urinary Tract Infection / Cystitis
Your doctor may ask you to turn in a urine sample to determine if pus, red blood cells or bacteria are present in your urine. A urinalysis sometimes followed by a urine culture, can reveal whether you have an infection. There is not a simple test that differentiates between an upper and lower urinary tract infection; the presence of fever and side pain indicate that the infection possibly involves your kidneys.
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Frequent Urination
Your doctor will request a medical history along with a physical examination; you will also be asked questions to help determine your condition. Such as:
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What is your daily void schedule? Is this more or less than normal?
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How did the abnormal frequency begin and what is the duration of the frequency?
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Are there any related urinary signs or symptoms, such as painful urination, urgency, incontinence, hematuria, discharge, or lower abdominal pain with urination?
You will also be asked about neurologic symptoms, such as muscle weakness, numbness, or tingling. Urinalysis, culture and sensitivity tests will most likely be performed.
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Urgent Urination
The diagnosis of an overactive bladder or urgency includes a complete medical history, together with a voiding diary and a physical examination. Paired with one or more diagnostic procedures, this helps your doctor determine the optimal treatment plan for overactive bladder.
The urine examination may discover medical conditions associated with urgency, such as the following:
- Bacteriuria - existence of bacteria in urine; indicator of infection
- Glycosuria - surplus glucose in urine; may point to diabetes
- Hematuria - blood in urine; may be a sign of kidney disease
- Proteinuria - excess protein in urine; may signify kidney disease, cardiac disease, blood disease
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Urinary Retention
The diagnosis of urinary retention includes both a medical and physical examination, for men a prostate examination will also be conducted.
- A thin, flexible tube, known as a catheter, will be placed in your urethra. It maneuvers into your bladder and releases the urine into a bag. This is conducted both as a diagnosis and as a treatment of the immediate symptoms.
- In order to check for signs of infection, bladder irritation, stones or other problems, a urine sample will be performed.
- Additional lab tests may be completed, depending on your doctor’s determination from your medical interview and exam.
[Top] Bladder Cancer
Bladder cancer is usually detected as part of the work up for hematuria or unexplained urinary systems. A detailed description of the hematuria workup is discussed in the following section. For a detailed discussion of the diagnosis and management of non-invasive bladder cancer, click here for the American Urological Association’s clinical guidelines.
Smoking is the leading cause of bladder cancer. Although the risk of developing bladder cancer decreases with smoking cessation, there continues to be an increased risk of bladder cancer for the next twenty years.
Hematuria
Your doctor will take a complete personal and family medical history. The personal history will provide useful information such as:
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Alcohol, tobacco or drug usage
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Exposure to toxic substance for the last 25 or more years
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History of kidney stones
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Any injuries and infections
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Recent illness
- Urinary or voiding history
EVALUATION
The evaluation consists of taking a history and doing a physical exam of the individual and an analysis of the urine under a microscope. Many questions about one's urinary tract, including urination habits, stone disease, infections and injuries, will be asked. In addition, we will ask about recent illnesses, family history, drugs used in the recent past, prior operations, social habits such as drinking and smoking, and work related exposures. Regardless of the information generated, we will almost always continue with the diagnostic tests to look at the entire urinary tract. Even if we suspect something from the history, we must try to prove that nothing potentially harmful is also present.
There are usually two diagnostic tests necessary to give us a look at the entire urinary tract. The intravenous pyelogram (IVP) and cystoscopy.
IVP or INTRAVENOUS PYELOGRAM
The intravenous pyelogram or IVP is a special x-ray of the urinary tract. A series of x-rays are taken before and after a special colorless dye is injected into the veins. The dye, which contains iodine, fills the urinary system and multiple films are taken over a 30-minute period looking for abnormalities. A pressure balloon may be placed on your stomach to help fill out the system better. At the end of the procedure the x-ray technician will ask you to empty your bladder in the bathroom and then one last x-ray film will be taken.
Because a dye is injected the possibility of an allergic reaction is present. A physician is in attendance and will administer the proper therapy if needed. If you have had a previous reaction to intravenous dye or are sensitive to shellfish, tell your doctor before the test. You are also exposed to very small amounts of radiation, so you must tell us if you think that you could be pregnant.
You will be given a prep sheet to describe the proper preparation for the intravenous pyelogram. Usually laxatives will be taken the night before the IVP and some fluid restrictions will occur the morning of the test.
CYSTOSCOPY
Cystoscopy is a procedure that is used to visually inspect the bladder and the urethra (tube leading out of the bladder). This can be done in most instances without discomfort by the use of a local anesthetic jelly (not a shot). The cystoscope or telescope, which is narrower than the urethra, is passed into the bladder and the inspection is carried out. The entire exam takes less than 10 minutes.
Afterwards you might expect a line discomfort with voiding and perhaps a spot of blood for a day or so. A warm bath helps to relieve this irritation and will wash off the soap we've used to prep the area. You may receive antibiotics afterwards to prevent infection. A pelvic examination can be done initially or at the time of cystoscopy.
OTHER TESTS 
Other tests that might be needed depending on the findings of the IVP and cystoscopy are ultrasound or CT scan examinations of the urinary tract. These will be done if some question or abnormality is not answered or explained to the urologist's satisfaction. Other tests, such as special blood studies, are considered if some historical fact about you raises other possibilities.
In the end, we hope to find nothing seriously wrong with the urinary tract. In fact, the most common finding is that we cannot determine a cause of the bleeding. This is actually a good finding because it suggests that the cause is not something that will ever be harmful. Remember that the thrust of the work-up is to exclude harmful diagnoses such as cancers or stones. Many of the other diagnoses include inflammations of the kidneys (nephritis) and would require a kidney biopsy to make a diagnosis. If one's urinary function is normal and we do not find protein in the urine, then the nephritis is usually harmless. This makes the kidney biopsy more dangerous than the disease - so we elect not to go further in the workup.
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Bladder Control Problems
Depending upon the cause of bladder control problems, the treatment may involve behavioral modification (discussed below under the heading of urinary incontinence), a variety of medications that either relax the bladder or reduce resistance to the flow of urination, or surgery. To learn more about treatment for bladder control problems that are caused by prostate enlargement, click here.
Biofeedback
A special procedure called biofeedback is a painless and non invasive therapy used to treat various types of urological conditions. The goal of Biofeedback is to raise the patient's awareness and conscious control of their unconscious physiological activities.
Some of the urological conditions that benefit from Biofeedback Therapy include:
- Stress Urinary Incontinence
- Urge Incontinence
- Mixed Incontinence
- Fecal Incontinence
- Interstitial Cystitis
- Pelvic pain
- Chronic Prostatitis
Our biofeedback therapist collaborates with the physician and spends time talking to the patient, conducts a thorough evaluation of their individual situation, and determines a personalized treatment plan. A typical appointment with our biofeedback therapist generally takes one hour of the patient’s time. The treatment regime normally takes six to eight visits. Medicare and most private insurance plans cover these services. Patients can self refer or their physician can refer them for Biofeedback.
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Urinary Incontinence
Common at-home therapies, such as diet and medication alteration along with reduced liquid consumption before sleep, can immediately improve urinary incontinence. If simple treatments do not alleviate incontinence symptoms, other treatment methods may be used. Some treatment options include non-invasive outpatient procedures, medications, and surgery. In most cases, incontinence can be controlled or cured with proper treatment.
There are many treatments available for incontinence. One easy way to improve your continence is by doing pelvic floor muscle exercises. Your pelvic muscle stretches from your front pubic bone to your tailbone in the back. This muscle supports the bladder, large intestine and the uterus.
How to Find the Pelvic Muscle:
To find the pelvic muscle, Imagine that you are at a party and the rich food you have just consumed causes you to have gas. The muscle that you use to hold back the gas is the same one that you want to exercise. Some people find this muscle by voluntarily stopping the stream of urine. A man might stand in front of the mirror after bathing and tighten the muscle. You should see your penis rise slightly.
Exercising the Muscle:
Begin by emptying your bladder. Then try to relax completely. Tighten the muscle and hold for a count of 5 or 5 seconds. You should feel a sensation of lifting of the area around the vagina or of pulling of the rectum.
When to Exercise:
Do 15 exercises in the morning, 15 in the afternoon and 20 at night. Or else you can exercise for 10 minutes 3 times a day. Initially you may not be able to hold this contraction for the complete count of 5. However,start slowly and then build to 10 contractions over time The muscle may start to tire after six or eight exercises. If this happens stop and go back to exercising later.
Where to Practice these Exercises:
These exercises can be practiced anywhere and anytime. Begin practicing them lying on your bed. Once you have mastered them lying down, practice them sitting in a chair. Then advance to practicing them standing. Resting one foot on a small stool or rung of a chair may help to relax your abdomen.
Common Mistakes:
Never use your stomach, legs or buttock muscles. To find out if you are also contracting your stomach muscles, place your hand on your abdomen while you squeeze your pelvic muscle. If you feel your abdomen move, then you are also using these muscles. Avoid holding your breath. Inhale and exhale slowly while counting. In time you will learn to practice effortlessly. Eventually, work these exercises in as part of your lifestyle, tighten the muscle when you walk, before you sneeze, as you stand up, and on the way to the bathroom.
When will I notice a Change?
After 4 to 6 weeks of constant daily exercises you will begin to notice less urinary accidents, and after 3 months you will see even a bigger difference.
Can These Exercises Hurt Me?
NO! These exercises cannot harm you in any way. Most people find them relaxing and easy. If you get back pain or stomach pain after you exercise, then you are probably trying too hard and using stomach muscles. Go back and find the pelvic muscle and remember this exercise should feel easy. If you experience headaches then you are also tensing your chest muscles and probably holding your breath.
Practical tips for improving bladder control
Click here to open and print a downloadable PDF with this information, new window will open.
Urinary leakage also called urinary incontinence is defined as the accidental loss of urine caused by coughing, straining or not being able to get to the bathroom in time when there is a sudden urge to urinate. Millions of men and women experience some degree of urinary leakage. The steps listed below can help effectively manage urinary incontinence.
Step 1:
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Learn how to perform pelvic floor exercises (abbreviated PMEs) by contracting (squeezing) the muscles that are used to start and stop urine flow. These exercises can help prevent urinary leakage. Be sure not to contract facial, abdominal, or buttock muscles or lift your shoulders at the same time. Begin by contracting the pelvic muscles in “quick flicks” lasting 3-6 seconds at a time. Next, practice contracting pelvic muscles for longer periods of time until you can squeeze the muscles continuously for 10 seconds. Rest 10 seconds between each of the longer contractions. Gradually increase the number of 10-second contractions in a lying, sitting, and standing position. Try to perform 10 to 20 sets of the longer contractions three times daily in each position.
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If you smoke, quit.
Step 2:
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Record a three-day voiding diary. Make a list of 7 columns on a piece of lined paper. At the top of each column, list the time of day, type and amount of fluid intake, type and amount of food intake, amount voided in ounces, amount of leakage (small, medium, or large), activity when leakage occurred, and presence or absence of urgency. Record the appropriate information in each column for a total of three days. (2) Avoid foods.
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Avoid foods and beverages that are acidic or contain caffeine since they can irritate the bladder. Also drink at least a quart of water daily. Dehydration causes constipation and produces acid urine that irritates the bladder and increases urine odor.
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Refer to the bladder diary and identify things that cause urinary leakage and avoid them if possible. Also, try urinating “by the clock” at regular intervals before the onset of urgent urination. For example, if you leak when you wait more than 2 hours to urinate, set your watch and urinate every hour and a half. If you continue to experience urgent urination, ask your healthcare provider about prescribing anti-spasm medication.
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Practice ‘freezing and then squeezing’ three quick PMEs (quick flicks) when a sudden urge to urinate strikes. Once the urgency sensation passes, proceed directly to a restroom and urinate. Before changing position or coughing, practice three quick flicks of PMEs and hold the last contraction while changing position.
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Use a moist wipe after urinary leakage to cleanse the skin, and apply a protective moisturizing skin cream or a film-like material if the leakage is severe or skin becomes irritated. Deodorizing sprays and liquids and tablets can help contain urine odor. A variety of disposable and reusable absorbent products are available for mild, moderate, and severe urine loss. Other devises to control urinary leakage are also available if necessary. Detailed information about products and where to buy them is available from the National Association for Continence 1-800-252-3337, www.nafc.org.
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Assemble a “spill kit” with protective skin wipes, a zip-lock plastic bag for disposal, and a spare absorbent pad. Keep a spare kit in a pants or coat pocket, in the car, and at work.
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Wearing dark pants and using protective pads on upholstery and bedding can provide added security.
Step 3:
Spiritual Care: It is normal to experience mood swings when you have a chronic condition such as urinary incontinence. Share your concerns with your partner, health care provider, and spiritual counselor. Honest communication can dispel unspoken fears and make it easier to handle things.
Step 4:
Treatment: If urinary leakage doesn’t respond to the measures listed above and it adversely impacts your quality of life, talk to one of our AUNC practitioners about other options that may be available.
Step 5:
Don’t give up hope.
Click here to download a PDF entitled "Overview of the Management of Post-prostatectomy Urinary Incontinence" by Mark W. McClure, MD, FACS Cheryl McClure Elliott, RN, MSN, ANP
Biofeedback
If self-taught measures do not improve urinary continence, biofeedback instruction will often enable patients to improve or resolve urinary control. [Top]
Urodynamics
Urodynamics is the investigation of the function of the lower urinary tract - the bladder and urethra - using physical measurements such as urine pressure and flow rate as well as clinical assessment.
The assessment begins with a medical history and examination, which may for example reveal abnormalities within the lower abdomen or pelvis that are contributing to the lower urinary tract symptoms.
The patient is then given a urination (voiding) diary to be kept for three days, to document their fluid intake and output, including episodes of incontinence. This provides information about bladder capacity, the frequency of passage of urine and episodes of incontinence and getting up at night to urinate. The diary can also outline other problems such as excessive fluid intake.
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