Bladder and bowel health issues may be caused by many things, and therefore a comprehensive assessment will include asking you about a range of health, medical and lifestyle questions. In addition to questions concerning your bladder and bowel health issues, the length of time that these symptoms have been occurring, and when they occur you will also be asked a series of other questions. 

The questions are intended to gain a thorough understanding of your bladder and bowel function and can help to indicate what options might be best suited to you.  

Questions you may be asked may include questions on your current and past history of: 

  • health and disability conditions 
  • operations and investigations 
  • medicines
  • women – history of pregnancies and childbirth 
  • occupational and lifestyle factors (e.g. history of lifting heavy weights) 
  • fluid and dietary intake
  • bladder habits
  • bowel habits 
  • pelvic pain 
  • sexual health issues 
  • psychological health issues

Tests that may be done may include:

Urine test

Your health care professional may test your urine with a urine test strip and/or may ask you to provide a sample of urine for testing by a pathology service. 

Urine testing is helpful to show if there are signs of infection, blood, and abnormal levels of glucose (sugar) in the urine.   

Test of stool sample 

If your doctor suspects that you may have an infection ion the bowel a sample to stool may be sent to a pathology service. 

Examinations may include:

Ultrasound scan of bladder and/or kidneys 

An ultrasound of your bladder can show is there are any features such as thickness and shape of the bladder that need further investigation. An ultrasound can also show how much urine the bladder is holding. An ultrasound can also show how much urine remains in the bladder after you have been to the toilet to pass urine.    

An ultrasonographer can also use ultrasound to examine the ureters and kidneys. 

Real time ultrasound

Real time Ultrasound is a painless non-invasive way to observe movement when a contraction of the pelvic floor muscles is attempted. The procedure involves an application of ultrasound gel applied to the lower abdomen, and then the transducer head is moved across the lower abdomen to detect movement in the pelvic floor muscles. Real Time Ultrasound can also be used to measure bladder capacity and to assess the Post Void Residual volume of urine after you have emptied your bladder. 

Many Continence Physiotherapists use Real Time Ultrasound when conducting a continence assessment.

Bladder scan 

A bladder scan is like a real time Ultrasound but is restricted to capturing an image of the bladder when it is full, and when it is empty. It cannot be used to observe pelvic floor muscle function. 

Urodynamics

Video urodynamics is a sophisticated investigative procedure to assess what happens within the bladder and surrounding structures as the bladder fills, empties and when you cough, sneeze or strain. The testing is invasive and involves having pressure sensitive catheters (thin tubes) being inserted in the bladder, urethra, and rectum. The test measures the pressure in the bladder at rest and during different situations such as filling and emptying to gain a better understanding as to how the bladder is working. 

Uroflowmetry 

This test involves passing urine into a special device. The device measures how many mls of urine re passed per second and the voiding pattern. A smooth bell-shaped curve correlates with a relaxed, normal voiding pattern, however other patterns such as a staccato pattern can indicate bladder outlet obstruction, whereas a “tower” pattern can indicate an overactive bladder.  

Cystoscopy 

A cystoscopy involves looking inside the bladder using a flexible tube that is inserted up the bladder tube (urethra) and into the bladder. This examination is good for detecting inflammation inside the bladder and to look for the presence of bladder stones and anatomical changes. 

Colonoscopy 

A coloscopy involves a long, flexible tube that passes up through the rectum and into the lower bowel. A colonoscopy is helpful to show any suspicious signs, including tumours, polyps, or other bowel conditions.  

Prior to the procedure you will need to drink a large quantity of bowel preparation so that the bowel is empty and easy to examine. 

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Kylie – parent of a child that wets the bed 

Kylie rang our service as she was concerned about her five-year-old daughter, Mia, who was wetting the bed. Kylie had tried limiting Mia’s drinks in the late afternoon and evening and was also getting up at night to wake Mia and take her to the toilet.

Our advisor explained that it may take children until they around 5 ½ years old before they gain bladder control during sleep. Kylie was advised to encourage Mia to drink well throughout the day and was cautioned against cutting out drinks in the afternoon and early evening. Kylie was discouraged from waking Mia at night to take her to the toilet. Kylie was provided with information on obtaining a referral from Mia’s doctor to a bedwetting clinic if Mia continues to wet the bed past 5 ½ years of age.

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Anastasiya’s story

“As a mum of two young children, I have experienced the joys of two pregnancies and postpartum recoveries. I was shocked after the birth of my first child to discover that my pelvic floor muscles had become weak. I sought advice from Bladder and Bowel Health Australia and learnt the importance of exercising these muscles. This knowledge helped, and because I was better informed second time around, I have now fully restored the dignity of my body and truly enjoyed the changes - and my motherhood. Thank you, Bladder and Bowel Health Australia, for informing young families about bladder and bowel health issues.” 

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Doreen – carer of her husband who has dementia 

Doreen was becoming exhausted caring for her husband Tom, who has dementia. Tom was not always making it to the toilet on time and needed his trousers to be changed several times a day. Every day Doreen was also washing bedlinen and the four towels that Tom was laying on at night as he was soaking through his pull-up pants. 

Tom was receiving a high-level Home Care Package, and Doreen was able to arrange with their provider for some of Tom’s package to be allocated to funding continence assessment and management.  

Our advisor went to Tom’s home and conducted a thorough continence assessment. A continence management plan was developed with input from Doreen, and appropriate incontinence aids and linen protection were organised. Doreen is relieved that Tom’s incontinence has reduced, and her washing load has lessened. Doreen is now confident that she can continue caring for Tom in their home. 

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Gary – experiencing leakage after his recent prostate surgery 

Gary met with one of our Bladder and Bowel Health advisors, as he was concerned about his urine leakage that was persisting after his radical prostatectomy five weeks earlier.   

Gary discussed his concerns with the advisor and was reassured that he was making good progress towards regaining bladder control. This reinforced the information he had received from his urologist. Gary was encouraged to switch to a smaller incontinence pad rather than continuing to wear the pull- up incontinence pants he had worn since his surgery. The advisor arranged some smaller pads for him to trial and provided details on where he could buy them close to his home. 

Gary was encouraged to drink plenty of fluid (particularly water) and to increase his fruit and vegetable intake to avoid constipation. Gary was uncertain if his pelvic floor muscles were working properly and he was referred to a pelvic floor physiotherapist. Gary left the clinic in a brighter frame of mind, confident that he was improving and had clear strategies to further support his recovery.