Incontinence is really diagnosed by you. While doctors and labs can offer some additional testing and help characterize certain features of the problem, none of them really understands the impact incontinence truly has on a person’s day-to-day existence. Since you are the one living with it, only you can truly say how troublesome it is and whether treatment is required.
Degrees of Incontinence: Mild
Some people experience only very mild incontinence. Most notably, there are tens of millions of people who have a small amount of urinary leakage when they cough or sneeze or jump. And often for these folks, there’s really no special treatment required, primarily because they would characterize it themselves as a minor nuisance. When I hear about this degree of incontinence, I usually recommend a program of pelvic floor exercises because the data does suggest the exercises can help, and particularly with a low level of symptoms.
Degrees of Incontinence: Moderate
Millions more describe that the problem is moderate severity, definitely more than a minor nuisance. It is downright inconvenient and it’s diminishing their quality of life by interfering with their sleep, their confidence and their social activities. Those are no small things. As a doctor, no matter what any testing shows, these are the elements that truly matter – what impacts the problem is having upon you as an individual and your quality of life. Normally, when I hear these kinds of symptoms, I recommend that we get to work on treatments because resolving the problem can have a big impact on improving quality of life.
Degrees of Incontinence: Severe
Finally, some individuals describe that the incontinence problem is very serious. They are soaking pads, experiencing interrupted sleep every single night, totally curtailing important social outings such as bridge club, church, visiting with friends, and on and on. Clearly, there’s nothing more important to a doctor than helping someone live a fuller, more satisfactory life.
So the diagnosis and severity is determined by you, the most important individual in any transaction with the medical world. A few questions can sometimes help us in the medical profession quantify the severity. We use some standard questionnaires that give a score for the severity of urinary or fecal incontinence. A physical exam can help the surgeon understand if there is an anatomical problem, a prolapse, or a loss of nerve signal strength. Sometimes testing can shed a little bit of light on the nature of the incontinence. For example, manometry studies provide excellent insight into the damage of the nerves and muscles that result in poor sphincter tone and diminished ability to squeeze the all-important muscles that prevent leakage. Urodynamic studies can offer somewhat important information about the capacity, relaxation, and emptying of the bladder.
But by far the most important piece of data is your experience and what life is like with this troublesome problem. The treatments are imperfect, but nowadays have become much more successful and much less invasive. So let your doctor know the symptoms you are experiencing and find out about the minimally invasive solutions available today that can solve the problem without chronic medication side effects or invasive surgery.