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If you're suffering from incontinence (the inability to control urination), don't be afraid to tell your health care professional what you're experiencing. By talking with your health care professional, you can find out why you're having bladder control and urinary leakage problems, and what kind of treatment is best for you. Remember, incontinence is not a disease: it is a symptom of one or more of a wide range of conditions. Make sure you tell your health care professional what prescription and over-the-counter medications you are taking, as many drugs can contribute to incontinence.

To diagnose the cause of your incontinence, your health care professional will first ask questions about your urinary habits and medical history. You should receive a thorough physical examination, including a pelvic exam, in which your health care professional will look for medical conditions that may be causing leakage, such as infections, tumors or impacted stool.

Constipation, or infrequent bowel movements that pass small amounts of hard, dry stool, can cause the stool to pack the intestine and rectum so tightly that the normal pushing action of the colon can not move and discharge the stool. This condition, known as impacted stool or fecal impaction, occurs most often in the elderly or nursing home populations. It can produce urinary incontinence as the packed intestine and rectum swells and presses against the urinary tract, blocking flow of urine. Loosening and removing the impacted stool, usually by taking softening medication and having a health care professional break up and extract the stool with a finger inserted in the anus, relieves the urinary incontinence.

You may be asked to keep a diary of your urinary patterns for at least three days, up to a week. In the bladder diary, you record what, when and how much liquid you drink; how many times you urinate and how much; how many leaks you have; whether you felt an urgency to urinate; and what you were doing at the time you experienced a leak.

Your health care professional may also perform some tests, depending on the type and suspected causes of your incontinence, including:

• Urinalysis, in which you will provide a sample of your urine that will be analyzed for the evidence of blood, infection, urinary stones and other abnormalities that can cause leakage.

• Cough stress test, in which you first relax and then cough while your health care professional looks for urine leakage. This test checks for stress incontinence, and is best performed in an upright position.

• Post-void residual (PVR) measurement test that is performed to see how much urine remains in your bladder after urination. In this test, you drink fluids and urinate into a measuring pan. Then, your health care professional drains the remaining urine in your bladder for measurement by inserting a small, pliable tube, called a catheter, through the urethra into the bladder. Alternatively, your health care professional measures the urine remaining in the bladder by using pelvic ultrasound, in which a machine directs sound waves at the bladder and produces shadowy images from which the amount of urine in the bladder can be determined. Generally, PVR readings of 50 milliliters or less are considered normal, while readings of 100 to 200 milliliters or more merit further investigation. Your health care professional can explain what your PVR readings mean.

• Blood tests to check levels of substances in the blood that might be related to disorders or diseases that may cause incontinence.

If the results of the basic evaluation and initial tests fail to point to a definitive diagnosis, your health care professional may refer you to a specialist, such as a urologist, who treats urinary tract disorders, or a urogynecologist, who treats on urinary tract problems in women. Your health care professional also may recommend the following additional tests:

• Cystoscopy, a test that uses a tiny telescope-like instrument that allows your health care professional to see inside the bladder and urinary tract and examine them for problems. You may be given some medication to relax you before the test, which involves inserting a thin tube that contains a miniature camera through the urethra and into the bladder.

• Urodynamic testing, which assesses bladder and sphincter function, including the pressure and volume of urine in the bladder, and the pressure and flow of urine from the bladder through the urethra. One test, called cystometry, measures contractions of the bladder muscle as it fills and empties by inserting a catheter through the urethra into the bladder and filling it with water or a gas. Sometimes, another tiny tube is inserted into the rectum to measure pressure on your bladder when you cough or exert pressure. Urodynamic testing also may include imaging, such as x-rays or ultrasound, to examine changes in the position of the bladder and urethra during urination, coughing, or straining.

Be sure to discuss with your health care professional, which tests are best for you, the exact procedures that will be followed when they are conducted, and what the results mean in assessing your bladder control problem and developing an appropriate course of treatment.