Sometimes I think medicine seems like a foreign world to people.  It feels strange and maybe full of weird words and testing that doesn’t make sense.  I spend so much time thinking about the bladder and living in this world that I may forget how new it is to you.  So let’s talk about making a diagnosis.  I can usually figure out what your bladder is doing by talking to you and examining you.  But there are times when I need to do some testing.  The most common tests that we need are urodynamics, a standing cough test, cystoscopy, and imaging of the kidneys.  I’m going to discuss each type of testing in a different post.  But let’s start with a standing cough test.

How is a standing cough test performed?

A standing cough test is a pretty simple test.  Unlike other tests, nothing is put in the bladder or urethra.  You come to the office with a full bladder.  I then have you stand with your legs separated  (pants off) on a medical towel.  Then you cough and I look at the towl to see if you leaked.  If you don’t leak, you may have to try again or do something else that makes you leak.  Some women will do jumping jacks or run in place.  If the activity forces urine out, you have stress urinary incontinence.

What can I expect?

Sound simple?  It is and it isn’t.  Even when you leak regularly, it is hard to leak in front of someone.  You won’t mean to, but you will squeeze your pelvic floor trying to stop the leak.  You may have to try a few times.  I expect this and can work with it.  It is pretty normal that I have to coach you through the test.

This simple test can also feel super embarrassing.  It shouldn’t but it does.  I do this test because surgeries aren’t perfect.  If I can’t see you leak in the office, I’m not sure a surgery will correct your leaking.  And you are in the office because you leak.  And i see leaking all day.  But the embarrassment is real.

This test can also show urgency urinary incontinence.  If you cough and then feel like your whole bladder empties and you have a large, long leak- that is urgency urinary incontinence.  During a stress incontinence leak, you only leak WHILE you are doing the activity.  So once the cough is over, so is the leaking.

What if it doesn’t work?

If you don’t leak during a standing cough test, I often move on to urodynamics.  But usually a standing cough test will give me the answer I need.  You shouldn’t feel worried about the testing.  You should feel like you and your medical practioner are a team and figuring things out together.