Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 14, 2026
How Is Urinary Incontinence Diagnosed?
Diagnosing urinary incontinence is usually straightforward and doesn’t require invasive testing. Most of the information your doctor needs comes from listening to your story, examining you, and reviewing simple tests. The goal is to determine what type of incontinence you have and what’s contributing to it, so treatment can be appropriately targeted.
What to expect at your evaluation
Your medical history is the most important part. I’ll ask about:
- When leaking happens, whether during activity, with urgency, or both
- How often and how much you leak
- What triggers your symptoms
- Your fluid intake and bathroom habits
- Pregnancies, deliveries, and any pelvic surgeries
- Medications you take
- How symptoms affect your daily life
A detailed conversation tells me more than almost any test. By the time we’ve talked through your symptoms, I usually have a good idea of what type of incontinence we’re dealing with and what treatment options make the most sense for you.
Physical examination
During a pelvic exam, I can:
- Assess the strength and coordination of your pelvic floor muscles
- Check for prolapse (descent of pelvic organs)
- Evaluate the health of vaginal and urethral tissues
- Perform a cough stress test, where I ask you to cough with a comfortably full bladder while I watch for leaking
The cough stress test is one of the most useful parts of the exam. Seeing urine leak at the same moment you cough is a reliable sign of stress incontinence, with a positive predictive value of 78-97%. If no leaking is seen lying down, I’ll repeat the test standing, which is more sensitive.
Simple tests
- Urinalysis to check for infection, blood, or other abnormalities
- Bladder diary, a 2-3 day log of your fluid intake, bathroom trips, and leaking episodes
- Post-void residual, a quick ultrasound to measure how much urine stays in your bladder after you empty it
The bladder diary deserves special mention. It’s one of the most helpful tools I have. Tracking what you drink, when you go, and when you leak for a few days gives me objective data about your bladder patterns. It often reveals things we can work on right away, like intake timing or voiding habits, that might already be contributing to your symptoms.
When more testing is needed
Most women can be diagnosed and begin treatment without advanced testing. A large randomized trial (the VALUE study, 630 women) showed that for uncomplicated stress incontinence, a basic office evaluation works just as well as adding urodynamic testing. Outcomes at one year were the same in both groups.
That said, urodynamic testing may be worth considering if:
- Your symptoms don’t fit a clear pattern
- Previous treatments haven’t worked
- You’ve had prior incontinence or pelvic surgery
- There’s prolapse beyond the opening of the vagina
- You have neurological conditions affecting bladder function
- Your cough stress test is negative despite leaking symptoms
I try to keep the evaluation as simple as possible. For most women, we can make an accurate diagnosis and talk through treatment options based on our conversation, the exam, and basic tests. I only recommend urodynamics when the results would genuinely change our approach.
References
- Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017;318(16):1592-1604. doi:10.1001/jama.2017.12137
- Nager CW, Brubaker L, Litman HJ, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med. 2012;366(21):1987-1997. doi:10.1056/NEJMoa1113595
- ACOG Committee on Gynecologic Practice; American Urogynecologic Society. Evaluation of uncomplicated stress urinary incontinence in women before surgical treatment. Female Pelvic Med Reconstr Surg. 2014;20(5):248-251. doi:10.1097/SPV.0000000000000113
- ACOG Committee on Practice Bulletins; American Urogynecologic Society. Urinary incontinence in women (Practice Bulletin No. 155). Obstet Gynecol. 2015;126(5):e66-e81. doi:10.1097/AOG.0000000000001148
- Hashim H, Blanker MH, Drake MJ, et al. International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function. Neurourol Urodyn. 2019;38(2):499-508. doi:10.1002/nau.23917
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