Involuntary leakage of urine can generally be classified as one of two types, but the two may co-exist:

• Urge incontinence (leakage for no apparent reason after an urge to urinate)
• Stress incontinence (leakage with cough, sneeze, etc.)

How is incontinence evaluated?
The first step is to see a doctor who has experience in diagnosing what type of incontinence is present and helping guide treatment. A urologist specializes in the urinary tract, and some urologists have further training and specialize in bladder function problems in women and men. Some nurses and other health care providers often provide rehabilitation services and teach behavioral therapies such as fluid management and pelvic floor strengthening.

Your doctor will first ask about symptoms of your pattern of voiding, urine leakage if present and other medical history. Some specialists will have you fill out a bladder or voiding diary over several days. This diary should note the times you urinate and the amounts of urine you produce. You can also use the bladder diary to record your fluid intake, episodes of urine leakage, and estimated amounts of leakage. To measure your urine, you can use a special pan that fits over the toilet rim.

Your doctor will physically examine you for signs of medical conditions causing incontinence. In some patients, weakness of the pelvic floor leading to incontinence may also result in pelvic prolapse, where the vagina, bladder or uterus begins to protrude out of your body. The presence of pelvic prolapse is evaluated on physical examination on your first visit.

Depending on the type and severity of symptoms, you may begin treatment the same day with combinations of behavioral modification (modification of diet, fluid volume, caffeine use, and pelvic muscle exercises or therapy), and sometimes medication.

Some patients will require further bladder testing to sort out what type of incontinence is present, how severe it is, to help guide treatment. Additional testing may include:

• Bladder stress test—the doctor watches for urine leakage when you cough hard with a full bladder.
• Urinalysis and urine culture—your urine is tested for infection or other contributing causes.
• Ultrasound—this can evaluate the kidneys, and can also check how well your bladder empties.
• Cystoscopy—the doctor inserts small telescope in the urethra to evaluate the inside of the bladder and urethra.
• Urodynamics—a computerized bladder and urethra test that can help identify the type and severity of incontinence.