The first steps your doctor will take to learn the cause of your urinary incontinence are a medical history and a physical examination. The physical exam will include examination of the penis, the prostate, and the nervous system. The history and exam, along with routine diagnostic tests such as a urinalysis, often provide enough information to determine the cause of the incontinence and enable your doctor to start treatment.

Your doctor may ask you to keep a voiding log, which is a record of the amount of liquids you drink and how much and how often you urinate.

Tests that may be done to determine the type and cause of your urinary incontinence include:

• Urinalysis and urine culture, which may be done to learn whether a urinary tract infection (UTI) or prostatitis are present or whether there is blood or sugar in your urine.
• Cough test to check for urine leakage while coughing.
• Urodynamic tests, which could include tests to look for hesitancy or interruptions of your urine flow, to measure the volume of urine left in your bladder after urination (post-void residual), and to measure how much urine in the bladder causes you to have a strong urge to urinate. The actual tests done vary from person to person. Urodynamic testing may include:
  • Uroflowmetry. The uroflowmetry test measures the rate of urine flow during urination. During the test, a flow curve will be charted to determine the peak flow rate. A low peak flow rate may be suggestive of an obstruction or a weak bladder causing the incontinence.
  • Pressure flow studies, which measure pressures produced in the bladder as the flow changes. Pressure studies may help distinguish between urinary symptoms caused by obstruction and those caused by a problem affecting the bladder muscles or nerves. This test is often used when the cause of a man's symptoms is uncertain.
• Residual urine determination. Your doctor may measure your post-void residual volume by inserting a thin tube (catheter) into your bladder or by using a bladder ultrasound scan immediately after you have urinated.
• Cystometrogram (CMG). This test evaluates your bladder's ability to store and release urine.
• Electromyogram (EMG), which is used to record the electrical activity of muscles.

Your doctor may conduct a cystoscopic exam (a test that allows your doctor to see inside the urinary tract) to rule out other causes of incontinence.

Further tests may be required if initial treatment for incontinence has failed. Other tests may also be needed if you have had previous prostate surgery, radiation therapy, or frequent urinary tract infections, or if a catheter cannot be easily placed into your bladder.

Tests such as cystourethrogram, an X-ray taken of your bladder and urethra while you are urinating, are not often used to evaluate incontinence, but they may be helpful. If your doctor wants to do one of these tests, ask whether the test is necessary to diagnose your type of incontinence.