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Saturday, 20 Oct 2018

Urinary Incontinence

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Urinary incontinence is a loss of bladder control whereby urine leaks from the bladder. It becomes more common as people get older and affects as many as 1 in 3 Americans age 60 or older.

There are different types of incontinence:

  • Stress incontinence (SUI) is a leaking of urine that happens with exertional activities like exercise, coughing, sneezing or laughing. It is caused by pelvic muscles or ligaments that are too relaxed. SUI common problem for women after childbirth. The pelvic muscles or ligaments may have been stretched or torn during childbearing or by prior pelvic surgery. Also, during the first 3 months of pregnancy, the growing uterus presses on the bladder and may cause leakage of urine. This is often less of a problem after the fourth month because the uterus rises out of the pelvis and doesn't put as much pressure on the bladder. Later in pregnancy, when the baby drops lower into the pelvis, SUI may be a problem again. 
  • Urge incontinence happens when a person feels the urge to urinate and cannot hold the urine long enough to get to the toilet. It can be associated with Parkinson's disease, stroke, or multiple sclerosis. But healthy people can have it, too. When an exact cause cannot be found, the problem is referred to as Overactive Bladder Syndrome. 
  • Overflow incontinence is common in older people, especially men who have an enlarged prostate gland. The enlarged prostate obstructs the urethra, which is the tube that drains urine from the bladder. The bladder does not empty completely and often remains full or partially full after urinating. This can lead to leakage of small amounts of urine. 
  • Functional incontinence happens when you are unable to get to the bathroom in time to urinate because of inability to recognize the need to do so and is often due to problems such as Alzheimer's disease or severe arthritis.

Incontinence may be worsened by problems such as:

  • constipation 
  • urinary infection 
  • a stone in the bladder 
  • use of diuretics ("water pills") 
  • thinning of tissue due to post-menopausal vaginal estrogen deficiency which may weaken the urethral sphincter muscles

Your doctor will obtain a medical history and perform a physical examination.  A urine sample will be checked for infection.  Treatment ultimately depends on what is causing the problem and may include:

Stress incontinence (SUI)

  • Incontinence pads and undergarments 
  • Kegel exercises to strengthen weak pelvic muscles 
  • Magnetic Induction (NeoControl) for “Super Kegels” 
  • Radiofrequency of bladder neck (RENESSA) 
  • PeriUrethral Bulking (Macroplastique or Coaptite) 
  • Trans-Vaginal Slings / Mid-Urethral Slings

Urge incontinence

  • Medications (anticholinergics like Vesicare and Gelnique) that help to relax the Overactive Bladder 
  • Timed Voiding, is an approach that teaches the person to empty the bladder on schedule (every one to two hours) rather than waiting until the urge is felt. For urge incontinence, Timed Voiding can make a big difference. The schedule can be adjusted to best meet one’s needs. 
  • Neuro-modulation via Peripheral Tibial Nerve Stimulation (PTNS) or InterStim sacral nerve S3 stimulation 
  • Vaginal Estrogen Replacement Therapy 
  • Bladder BOTOX injections

Overflow incontinence

  • Medication to shrink the prostate (Avodart) or relax the bladder outlet (Rapaflo, Flomax, Uroxatral) 
  • Minimally Invasive Thermal Therapy (TUMT or Prostiva) 
  • Trans-Urethral Resection of Prostate (TURP) done by either Plasma or Laser technology

Functional incontinence

  • Treat the underlying disorder 
  • Chronic “Foley” catheter or supra-pubic catheter 
  • Incontinence pads and undergarments