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Urinary Incontinence

What is urinary incontinence?

urinary-incontinence-videoUrinary incontinence is the involuntary loss of urine. It is not a disease but rather a symptom that can be caused by a wide range of conditions. Incontinence can be caused by diabetes, a stroke, multiple sclerosis, Parkinson’s disease, some surgeries or even childbirth. More than 15 million Americans, mostly women, suffer from incontinence. Although it is more common in women over 60, it can occur at any age.

What are the various types of urinary incontinence?

Stress Incontinence:

  • The most common type of leakage.
  • Occurs when urine is lost during activities such as walking, aerobics or even sneezing and coughing due to both the abdominal pressure associated with these events and weakened pelvic floor muscles.
  • Weakened pelvic floor muscles can be a result of previous childbirth or surgical trauma.
  • Menopausal women can also suffer from small amounts of leakage as a result of decreased estrogen levels.
  • In men, the most common cause of incontinence is prostate surgery, such as with a radical prostatectomy.

Urge Incontinence:

  • Often referred to as “overactive bladder.”
  • Occurs when a person has an uncontrollable urge to urinate but cannot reach the bathroom in time and has an accident.
  • Some people have no warning and experience leakage just by changing body position (e.g., getting out of bed).
  • Associated with strokes, multiple sclerosis and spinal cord injuries.

How is urinary incontinence diagnosis made?

First a thorough medical history and physical examination will be conducted. This will be followed by a urinalysis and cough stress test will be conducted at your first consultation. If some findings suggest further evaluation, other tests may be recommended — such as a cystoscopy or urodynamic testing. Both of these tests are performed on an outpatient basis.

What are some treatment options for each type of incontinence?

In most cases of incontinence, minimally invasive management (fluid management, bladder training, pelvic floor exercises and medication) is prescribed. However, if that is unsuccessful, surgical treatment can be necessary.

Stress incontinence

Males: Use of urethral injections of bulking agents to improve the function of the sphincter. The injections are done under local anesthesia and can be repeated. The most effective treatment for male incontinence is implantation of an artificial sphincter.

Females: Initially, treatment options include behavior modification and pelvic rehabilitation. Techniques like biofeedback or electrical stimulation of the pelvic muscles can help. However, with more severe symptoms and the conservative measures did not help, the treatment is surgery. Surgical treatment options include several minimally-invasive procedures such as the use of bulking agents to the most common procedure, the sling.

Urge incontinence

There is a large array of treatment options available. The first step should be behavior modification — drinking less fluids; avoiding caffeine, alcohol or spices; not drinking at bedtime and urinating around the clock. Exercising the pelvic muscle (Kegel exercises) and other physical rehabilitation also helps. Often the treatment for overactive bladder is with medication. This consists of the use of bladder relaxants that prevent the bladder from contracting without the patient’s permission.

Other options available to patients, who do not respond to behavior modification and/or medication, include the implantation of a bladder pacemaker to control bladder function.  This latest technique, the Interstim®, consists of a small electrode that is inserted in the patient’s back close to the nerve that controls bladder function. The electrode is connected to a pulse generator and the electrical impulses control bladder function.

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