Many women treat their leakage without the help of a physician.  However, it is vital that you are plugged into good medical care.  I assume that you have a primary care doctor that you like and are up to date with all of your routine medical care (vaccines, lab tests, pap smears, physical exam, etc). But you might be wondering, “When should I see a doctor specifically for my leaking?” 

You are unique.  There are things about you that will only be realized through a complete history and physicial with a doctor.  Sometimes there are red flags that mean you need to see a doctor.  Here are some of the things that I consider when seeing a new patient with leaking:

Do I think you have a tumor or cancer?

Infrequently, a tumor or cancer can cause leaking. My mom had a uterine cancer and her first symptom was leaking.  So, this is something that I think about in every woman I see. Large pelvic tumors can press on the bladder and cause bladder symptoms while bladder cancers almost always irritate the bladder.  Sometimes, a pelvic tumor creates vaginal discharge that is mistaken for leaking urine. I ask about blood in the urine, about other symptoms like bloating or trouble eating normal amounts food, about irregular vaginal bleeding and your menstrual cycle and about the timing of your symptoms. Physical exam by a doctor is a really critical diagnostic tool.

Do I think you have an undiagnosed condition?

Many different medical conditions can have an indirect effects on the bladder. Back problems, diabetes, pregnancy and neurologic diagnoses like multiple sclerosis, are some of the more common conditions that can affect the bladder. I ask about other symptoms like numbness and tingling, visual changes, fatigue, and changes in appetite. Any of these symptoms mean you need to see a doctor.

Do I think you have an infection?

So while it is true that most women know when they have an infection, it is not true for everyone and for every bladder infection. Some infections cause unusual symptoms. We always look at your urine for signs of blood and infection.

Are your medications impacting your bladder?

Lots of medications impact the bladder and can cause either leaking or trouble emptying. Looking for a correlation between the timing of bladder symptoms and starting new medications is important.  The list of medications that impact the bladder is long and includes everything from antidepressants to cardiac medications. If the timing of your symptoms lines up with starting (or even stopping) a medication, talk to your doctor.

Is your past medical or surgical history a factor?

Again, lots of medical conditions can affect the bladder.  Diabetes and obesity (or weight gain) can cause the bladder to act up. Surgeries can directly effect the bladder and the bladder support and some surgeries can affect the nerve supply to the bladder. As I stated before, it is important to think about the timing of the symptoms and how it correlates to your personal history.

Do I think you are emptying your bladder well?

This may seem silly but not everyone can tell if they empty well. There are lots of reasons for this but it frequently means that those nerves aren’t working correctly (because you are right, if your nerves are working correctly, you should be able to tell). Evaluating emptying with a quick bladder ultrasound is an important step.

Next Steps

I can diagnose most of these medical conditions with a simple history, physical, ultrasound, and urinalysis.  You must be plugged into routine health care and know that you do not have blood in your urine (this has to be checked on a urinalysis to make sure there isn’t microscopic blood) if you are trying to treat your incontinence alone. If you have any concerning symptoms – you should see your doctor.

If you are looking for a specialist and are not sure what to do, there are national organizations that have lists of physicians who specialize in incontinence.  The National Association for Continence and The American Urogynecologic Society have excellent information.