The most helpful information for a doctor or other health professional to assist in diagnosing your problems is a brief history of any bladder symptoms you may have, for example:

• What is your major concern about your bladder/urination?
• How often do you urinate during the day/night?
• Do you leak when you laugh, or cough, or do you have an accident? How often? In what circumstances?
• Do you find it hard to begin urinating? Do you feel that you empty your bladder?
• Do you wear pads or protection? If so how often?
• When and how often have you had kidney infections?
• Do you have pain on urinating or blood in your urine?
• Have you had any formal investigations before, or are you taking any medications?

If responses to these questions suggest the existence of bladder problems, then it is likely that you will asked to take some tests.

Tests
Increasingly there are different tests being used to determine more accurately what the exact problem is. Your GP will probably only undertake
tests for urinary tract infections, and it will be your neurologist who may refer you to specialists, e.g. a urologist, for other tests, if necessary. The two most significant tests assess:

• urinary tract infection, and
• control of urinary flow.

Tests for urinary tract infection. Doctors are recognizing that urinary tract infections are an increasing problem for people with MS and often associated with retention of urine in the bladder. However, it is important that you ask your doctor to undertake such tests regularly. If your doctor suspects that an infection is present, a ‘mid-flow’ sample of your urine is normally requested and, after the specimen has been
‘cultured’ to identify the particular bacteria present, you will be prescribed the most appropriate antibiotic.
Tests for urinary flow. More and more sophisticated tests, known as
‘urodynamic’ tests, are being developed to measure ‘urinary flow’. A more recent test investigates this flow and the amount of urine remaining in the bladder after urination by taking a non-invasive ultrasound picture of your bladder. Of particular importance is the measurement of the amount of urine remaining in the bladder after you have urinated – it is this residue that can give rise to infection. This overall test, called an ‘ultrasound cystodynogram’ (USCD), is gradually replacing one that measures the rate of flow or urine by the introduction of a
‘catheter’ (a thin tube) through your urethra (the opening in your body from where urination occurs) to your bladder. The remaining urine then flows out and can be measured. To obtain additional information, further ultrasound pictures might be taken of your kidneys. Very occasionally, a far more intrusive investigation – ‘cystometry’ – is performed, usually only in very rare cases indeed, to allow the examination of the inside of your bladder (almost as a final resort after all other methods have been tried with no success), and when surgery is being considered. Surgery is rarely, however, considered for urinary problems in MS, for it is often associated with a range of side effects and difficulties.