Your doctor can diagnose overactive bladder by conducting a physical and neurological evaluation, reviewing your medical history, and conducting lab tests. Make sure to bring a list of your medications to your appointment. Some people may feel embarrassed about discussing “private” matters, but rest assured that your doctor respects and appreciates the information that you provide, as it helps in the process of diagnosing your problem. It is beneficial to write down your symptoms before your appointment and bring them to discuss with your doctor.
Common tests include blood tests and urine tests. Your doctor may ask you to keep a record of how much you drink and urinate and episodes of incontinence over several days. The information can help your doctor diagnose factors that may contribute to your symptoms.
Specialized tests may also be conducted. A uroflowmeter is used to measure the amount of urine and speed of your voiding. A post void residual (PVR) measurement helps to find out if you have a problem with emptying your bladder. After you have urinated, your doctor will use a catheter or ultrasound to assess how much urine is left in your bladder. A catheter is a soft thin tube that is carefully inserted into your urethra to your bladder to remove remaining urine for measurement. An ultrasound is a painless imaging test that uses sound waves to create a picture of the bladder and remaining urine. With either test, a large amount of remaining urine indicates a blockage in the urinary tract or a bladder problem.
Urodynamic testing is another test to learn more about bladder function. Urodynamic testing evaluates the muscle strength in the bladder walls and sphincter. For this procedure, a catheter is inserted into the bladder and then the bladder is filled with water via the catheter. A pressure monitor records the pressure within the full bladder. Pressure in a healthy bladder increases slightly while filling.
Bladder pressure can also be measured with cystometry. For this procedure a catheter is inserted into the bladder and the bladder is filled with water. A small pressure monitor is inserted through the anus and into the rectum. The device measures pressure changes in the bladder and surrounding areas while the bladder is filled to various capacities.
Video urodynamic testing is frequently performed at the same time as cystometry. Video urodynamic testing uses X-rays or ultrasound to show what the bladder looks like while it is filling and emptying. A special dye may be used to enhance the images.
Your doctor may use a cystoscope to view the inside of your lower urinary tract. A cystoscope is a thin tube with a viewing instrument. It is carefully inserted through your urethra. The bladder is expanded with air or water to open the bladder folds and provide a better view. The procedure (cystoscopy) allows your doctor to check for problems inside of the bladder and urethra. Narrow instruments can be inserted through the cystoscope to allow your doctor to remove tissue if necessary.
In some cases, electromyography is used to assess the way that nerves conduct signals to the bladder muscles or sphincter. The evaluation involves placing sensors on the skin, in the bladder, or in the rectum. The sensors transmit a record of how coordinated specific nerve signals are with each other.