Urodynamics

Urodynamics testing is often used to try and find out what is causing bladder problems. Here we give you the "low down" on what this test involves, and how you can prepare yourself.

Urodynamics is the study of the pressure of urine in the bladder, and the flow of urine leaving the bladder. Urodynamics testing can give useful information and may help work out the cause of bladder problems. This may help to choose an effective treatment too.

Why might the test be used?

You may have a bladder problem which is still something of a mystery to the doctors. Or you may already have a diagnosis, but the doctor needs more information on the extent of your condition. It could also be that your doctor is thinking about surgery, and the test can make sure the operation will help.

What does urodynamics tell you?

The test measures how long it takes to empty your bladder, and whether the flow of urine is even, or if it stops and starts. It measures the way the bladder contracts to start the flow of urine, and how much pressure there is in the bladder and urethra (the tube that carries urine out of the bladder).

Where is the test normally done?

You will be asked to go to a special hospital clinic for the test. It usually takes about an hour and a half to complete.

What happens?

No one can pretend that urodynamics is a pleasant procedure. But in good clinics, staff will do their best to put you at ease and make sure you are treated sensitively. One continence nurse specialist told us she tries to be aware of how her patients are feeling. "I make sure that there is privacy and that the person feels secure. I explain everything that I do and let them know that they can stop me at any time", she said.

The first thing you will be asked to do is to lie down on a couch. A fine tube, called a catheter, is inserted into your bladder - through the opening in the tip of the penis in men, and in the small opening above the vagina in women. A second very fine catheter is inserted at the same time. This is not painful, though it may be a bit uncomfortable. You will also have a third catheter inserted into your rectum (back passage).

The first catheter is used to fill your bladder with fluid. The second catheter is attached to a sensor which records the pressure inside your bladder. The third is also attached to a sensor, and it records the pressure in your abdomen. These sensors record the pressure in the bladder - and the changes in pressure as it fills up with fluid. They also record what happens when you cough or move around. All these catheters are linked to a computer which prints out a graph of all the changes.

Once your bladder is full you will be asked to stand and cough, and then to pass urine into a commode. The commode has a flow-meter inside it, again linked up with a machine which prints out the result. You should be able to do all this in private. The catheters are taken out as soon as the test is over.

In some clinics you may be given an X-ray which records what is happening on film. You lie down, and the X-ray machine is positioned above your bladder.

The report of these tests is then sent to the doctor investigating your bladder condition, or to your family doctor.

How have Incontact members felt?

Sue was well prepared for urodynamics, thanks to her continence advisor. "It really made a difference knowing exactly what to expect and why the test was being done. My continence advisor came with me to the clinic and there was a female clinician doing the test, which I felt helped."

Sue also appreciated not being treated like an idiot, and the way the staff allowed her privacy and dignity. "I was treated with great sensitivity", she says.

Unfortunately, not all consumers have such a positive experience. Colin did not find that the clinic staff inspired confidence. "The doctor was an hour late. Then the nurse who handed me the hospital gown and told me to put it on was a real battle-axe", says Colin. "I was told to stop taking in fluid when I was full" when I asked how I would know I was full, the doctor said 'you'll burst', in a very brusque way."

Colin thinks the main problem was the attitudes shown by the staff. "They didn't really appreciate the feelings of embarrassment, even shame, that anyone undergoing this sort of test has, and how people need to be treated with sensitivity and understanding".

What can you do next?

Have you had a bad or a good experience with urodynamics? Think about writing to the clinic and letting them know. Praise and encouragement reinforce good practice. And letters of complaint can be a powerful way of making people examine their routines and attitudes. You should send a copy of your complaint to the Complaints Manager of the health authority responsible, if you want to make sure action is taken. And don't forget to let Incontact know about any good or not-so-good experiences...we want to hear.

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