Testing for Pelvic Pain and Urinary Urgency or Frequency

Many or all of the following tests may be ordered to try to find the cause of your urinary symptoms. The following information describes each test and the clues it may give us about the cause of your symptoms.

Urinalysis

The urine is examined under a microscope to look for infection or blood.

Urine Cytology

Certain patients that are at high risk for bladder cancer (men over 40, smokers) should have urine cytology to look for cancer cells in the urine. The urine is sent to a special pathologist who examines the cells in the urine under a microscope and may perform special tests on the cells to look for cancer. Bladder cancer can cause pain, frequent urination, and the urgent need to urinate.

Urine culture

The urine is sent to a lab to culture the urine. This is the best test to rule out urinary infection.

Voiding Diary

A voiding diary is a test which a patient performs at home. The patient records the time of each void and the volume of urine voided. This helps to determine the cause of urinary frequency by documenting the amount of urine made and the bladder capacity. It is also very helpful in determining the reason for voiding multiple times at night.

Uroflow Test

This test is a measurement of the forcefulness of the urinary stream, the pattern of the urine flow, and the amount of urine voided. It can help to diagnose obstruction of the urinary passages or poor bladder contractions, and also is a measurement of bladder capacity.

CT Scan

This test is the most accurate test to look at the kidneys, bladder, and female organs to look for other causes of pelvic pain. It usually involves an injection of intravenous contrast material and patients need to drink oral contrast at the office prior to the study.

Bladder Ultrasound

This test is performed in the office immediately after a patient voids, and determines if a patient is emptying the bladder completely. Incomplete bladder emptying is one cause of needing to urinate frequently.

Pelvic Pain Questionnaire

This set of questions is a good guide to the severity of a patients symptoms and can give a clue to the cause. It is also a good measurement of a patient's response to various treatments.

Potassium Sensitivity Test

One common reason for pelvic pain, and the frequent, urgent need to urinate is an abnormality in the lining of the bladder. In these patients the urine irritates nerves deep in the bladder wall because the coating of the bladder lining is incomplete. The potassium sensitivity test is performed in the office. A small catheter is passed into the bladder and saline and/or potassium solution is instilled into the bladder. Patients with an abnormal bladder lining will be much more sensitive to the potassium solution. A rescue solution is instilled after the test is complete, so patients with a reaction will not leave theoffice with increased pain.

Cystoscopy

This test involves direct examination of the inside of the bladder with a telescope which is passed through the urethra into the bladder. This can be performed in the office, but we usually recommend that it be performed under heavy sedation or anesthesia so that a thorough inspection can be performed without causing pain. This test can find many causes of bladder problems, including bladder stones, tumors, endometriosis, or interstitial cystitis. It also allows us to determine the capacity of the bladder. If the procedure is performed under anesthesia then the bladder can be stretched, which gives relief of pain in half of the patients with pelvic pain.

Urodynamics

These tests are used to measure the function of the urinary tract. This includes bladder strength and causes of incontinence. It may be ordered in patients with urinary urgency, frequency, incomplete bladder emptying or incontinence.