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Home >> Women's Health >> Bladder Problems >> Diagnosis
 Bladder Problems - Diagnosis
Overview | Diagnosis | Treatment | FAQ
When you only have one symptom or if your symptoms are vague, it can be more difficult to determine the problem. If you are slightly dehydrated, your urine will be more concentrated, and urinating may cause discomfort. Drink enough fluids to keep your urine light yellow or clear like water – this will help decrease discomfort.
Below are just a few common urinary problems:
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.
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.
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:
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Bacteriuria - existence of bacteria in urine; indicator of infection
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Glycosuria - surplus glucose in urine; may point to diabetes
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Hematuria - blood in urine; may be a sign of kidney disease
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Proteinuria - excess protein in urine; may signify kidney disease, cardiac disease, blood disease
Urinary Retention 
The diagnosis of urinary retention includes both a medical and physical examination.
- 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.
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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
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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
Problems with bladder control can be caused by a variety of conditions. Similar to the workup for the conditions discussed above, assessment involves 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. In addition, patients are usually given a urination (voiding) diary, which is used 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. If the cause of bladder control problems is still uncertain, a special procedure called a urodynamic procedure may be performed. A urodynamic procedure investigates the filling and emptying 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.
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Urinary Incontinence
Urinary incontinence occurs when you are not able to control when you urinate. While embarrassing, this condition can be treated.
There are nearly 12 million adults in the United States that suffer from urinary incontinence. Whereas it is most commonly experienced in women over 50 years old; it may also affect younger people, especially women who have just given birth.
If you experience symptoms of incontinence, discuss with your doctor. If left untreated, you risk getting skin irritation or sores and urinary tract infections. Additionally, fear of embarrassment may lead to you avoiding friends and family.
Evaluation of the incontinent patient will focus on categorizing the type of incontinence being experienced. With this understanding, specific therapy can be recommended that is individualized to each patient.
If you are struggling with incontinence, it does not have to become a way of life for you. There are exercises you can do, and the latest surgical procedures can virtually "cure" this embarrassing problem. These surgical procedures include collagen injections and the transvaginal sling procedure.
If you are struggling with incontinence, see a urologist to determine the best treatment alternative for you. Remember—you're in control!
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