When a patient presents with symptoms of abnormal bladder functioning, their doctor or urologist will take them through a diagnostic process to determine the source of their symptoms and begin planning appropriate treatment.
Bladder problems can arise from a range of possible causes, including various medical conditions such as infections or neurological diseases, and a patient’s treatment plan needs to take into account the root cause of their symptoms. Treatment may also vary depending on how a particular patient’s symptoms manifest – for example, whether or not the patient experiences incontinence (bladder leaks), and what type of incontinence.
The diagnostic process typically begins with a doctor’s review of the patient’s symptoms, medical profile, and medical history, as well as a physical exam. For many patients, it also includes diagnostic tests to assess the functioning of the bladder. Keep reading to learn what a bladder function test is, how it works, and its role in the diagnostic process for overactive bladder and other bladder-related conditions.
What is a bladder function test?
Frequently called urodynamic testing, a bladder function test assesses the bladder’s ability to store and release urine. It can determine whether the bladder is contracting involuntarily, which can cause frequent urges and incontinence (leaks).
Though it is referred to as bladder function testing, urodynamic testing can involve any part of the lower urinary tract, including the bladder, sphincters, and urethra. Essentially, bladder function tests look at how well the system that controls urination is working.
Types of bladder function tests
The terms “bladder function test” and “urodynamic test” actually refer to a number of different tests. These include:
- Uroflowmetry – Measures “flow rate,” or how much urine is in the bladder and how fast it comes out. Slow or weak urination can be a sign of weak bladder muscles or blockage.
- Post-void residual urine measurement – Often performed by ultrasound or via catheter to remove and measure residual urine, this test can show if the bladder is not emptying fully.
- Cystometric test – Measures how much urine your bladder can hold, how much pressure builds up in the bladder as it stores urine, and how full your bladder is when you begin to feel the urge to empty it. This test is typically performed via catheter.
- Leak point pressure measurement – Typically performed during or right after a cystometric test, this test measures the pressure in the bladder if and when any leaks occur.
- Pressure flow study – After the cystometric test, this test measures how much pressure your bladder needs to empty and how quickly the urine flows at this pressure. This can identify blockages caused by prostate enlargement, anterior vaginal wall prolapse (cystocele), or a previous surgery.
- Electromyography – Sensors are placed on the skin or on a catheter to measure the electrical activity of the nerves and muscles in and around the bladder and sphincters. This can help determine whether bladder problems are the result of nerve or muscle damage.
- Video urodynamic tests – This test uses x-ray or ultrasound footage to record the bladder filling and emptying, sometimes using a special dye inserted via catheter.
Other diagnostic tests for bladder problems
The bladder function tests above directly assess the functioning of the parts of the lower urinary tract. Doctors may perform additional tests that do not directly measure bladder functioning but help provide a fuller picture of the patient’s symptoms.
For example, the doctor may have you do a cough stress test to determine whether you experience stress incontinence. You may also undergo neurological testing to rule out neurological diseases such as Parkinson’s. Finally, your doctor may perform a urinalysis, or a test of your urine sample, to identify the presence of infections (such as urinary tract infection, or UTI) or diabetes.
Who should take a bladder function test?
Doctors may recommend bladder function tests for anyone presenting with symptoms of bladder dysfunction, including those associated with overactive bladder (OAB). Such symptoms include:
- Bladder leaks
- Frequent urination
- Sudden or painful urges to urinate
- Problems fully emptying the bladder (urine retention)
For more information, learn about the signs and symptoms of overactive bladder.
After diagnosis: Treating bladder problems
The results of your bladder function tests will ideally provide clarity about the source and nature of your symptoms so that your treating doctor can help you plan the appropriate treatment. You may discover that your symptoms are tied to an underlying medical condition that needs to be treated. Or, you may be diagnosed with overactive bladder (OAB), a chronic condition characterized by frequent urination and possibly incontinence with leaks.
In the second case, the patient care pathway consists of the following steps, starting with more conservative treatments and moving to pharmaceutical and more advanced therapies if previous treatment strategies are not effective:
- Behavioral therapies: Behavioral therapies for overactive bladder include dietary changes, fluid intake monitoring, bladder training, and pelvic floor or Kegel exercises. Doctors may recommend that patients continue with these therapies in combination with the more advanced therapies listed below.
- Medication: There are several medications designed to increase bladder functioning. These medications vary in mechanism and the effect on individuals’ bodies. You and your doctor will need to consider any side effects or possible negative interactions with any other medications you take.
- Advanced therapies: If behavioral therapies and/or medication do not sufficiently resolve your bladder dysfunction, your doctor may recommend advanced therapies, some of which involve minor procedures or injections. One such therapy, Sacral Neuromodulation, is a guideline recommended therapy offered by Axonics.
Sacral Neuromodulation for Bladder Dysfunction
The Axonics System uses Sacral Neuromodulation to restore normal bladder functioning. With this therapy, a small implant delivers mild electrical impulses to the sacral nerve, stimulating healthier bladder function. Learn more about The Axonics System and whether this therapy is right for you.
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