Urinary Control * Incontinence
The North Texas Center for Urinary Control
Nearly 10 million Americans suffer from urinary incontinence and/or overactive bladder . Contrary to popular belief, urinary incontinence is not simply "something that effects older people." The truth is, it can affect anyone. This includes children, elderly individuals, women who have had children, anyone who exercises and men who have had prostate surgery. Incontinence can leave you exhausted, sleep deprived and make long-distance travel uncomfortable or even impossible.
In short, it keeps many from enjoying a full life. Yet, despite these frustrations, only about one in 12 people seek relief... often because they're embarrassed to seek treatment and also because many don't know just how many treatment options are available to them, non-surgical options in particular.
Says James Daniel Johnson, M.D. of UANT's Center for Urinary Control: "There is an undiagnosed epidemic among American households, one that leaves millions depressed, isolated and sometimes even housebound. Yet it is almost entirely curable. It is a problem that primary care physicians, with just a few moments of their time, could turn from a crippling, secret affliction to a routine part of maintaining wellness."
Urinary incontinence is defined as a loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. Most bladder control problems happen when muscles are either too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is called stress incontinence. If bladder muscles become too active, you may feel a strong urge to go to the bathroom when you have little urine in your bladder. This is called urge incontinence or overactive bladder.
What causes urinary incontinence?
The most common causes are:
- For women, thinning and drying of the skin in the vagina or urethra, especially after menopause
- For men, enlarged prostate gland or prostate surgery
- Weakened pelvic muscles
- Certain medicines
- Build-up of stool in the bowels
- Urinary tract infection
- Problems such as diabetes or high calcium levels
Types of incontinence
There are three types of incontinence. Treatment depends on the type of problem you have and what best fits your lifestyle. It may include simple exercises, medicines, special devices or procedures prescribed by your doctor, or surgery.
Stress incontinence-Caused when the pelvic muscles slip down and the bladder neck is not in the correct position. As a result, activities that increase pressure on the abdominal cavity and bladder, such as coughing, laughing, sneezing and exercising, can cause urine leakage.
Urge incontinence-Caused by an overly sensitive bladder, which feels full even when it contains even a small amount of urine. The bladder contracts unexpectedly and, if the external sphincter is weak, urine in the bladder is expelled. Symptoms of urge incontinence include going to the bathroom at least every two hours, and getting up frequently during the night.
Overflow incontinence-Caused when scar tissue or dropped organs make the urethra (urine channel) very narrow, or might arise temporarily after pelvic surgery or childbirth. Overflow can also occur when the bladder stops contracting due to medications, injured nerves, prostate enlargement or a habitually overstretched bladder. Some symptoms of overflow incontinence include getting up frequently during the night to urinate and dribbling urine throughout the day.
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 fails, surgical treatment can be necessary.
Stress incontinence - Men
For men, urethral injections of bulking agents to improve the function of the sphincter can be employed, but the cure rate with this treatment is only 10-30%. The most effective treatment for male incontinence is implantation of an artificial sphincter. The device is inserted under the skin and consists of a cuff around the urethra, a pressure-regulating balloon in the abdomen and a pump in the scrotum. The fluid in the abdominal balloon is transferred to the urethra cuff, closing the urethra and preventing leakage of urine.
Stress incontinence - Women
In women stress incontinence is treated initially with behavior modification and pelvic exercise. Sometime techniques like biofeedback or electrical stimulation of the pelvic muscles can help. But when the symptoms are more severe and conservative measures are ineffective, the treatment is surgery. In selected cases bulking agents can be used to increase continence. The operation is done under local anesthesia and is minimally invasive but the cure rates are lower compared to open surgical procedures. Another option is abdominal surgery, in which the vaginal tissues are affixed to the pubic bone. The long-term results are good but the surgery requires longer recuperation time and is generally only used when other abdominal surgeries are also required. The most common and most popular surgery for stress incontinence is the sling procedure. In this operation a strip of tissue is applied under the urethra to provide compression and improve urethral closure. The operation is minimally invasive and patients recuperate very quickly. The tissue used to create the sling can be a segment of the patient's abdominal wall, specially treated fascia, skin from a cadaver or a synthetic material such as polypropylene.
There is a wide range of treatment options available for this type of incontinence. The first step should be behavior modification - drinking less fluids; avoiding caffeine, alcohol or spices; not drinking at bedtime and urinating around the clock and not at the last moment. Pelvic muscle exercises also help. The most common treatment for overactive bladder is medication, such as bladder relaxants, that prevent the bladder from contracting without the patient's permission. Other alternatives can be considered in patients who fail to respond to behavior modification and/or medication, one of which is the bladder pacemaker. This treatment consists of a small electrode that is inserted in the patient's back and is connected to a pulse generator. The generator's electrical impulses control bladder function. This treatment has proven highly effective, with a 60-75% cure or improvement rate.
For overflow incontinence, the treatment is to completely empty the bladder and prevent urine leakage. Patients with diabetic bladder or patients with prostatic obstruction often develop this type of incontinence. Overflow incontinence due to obstruction should be treated with medication or surgery to remove the blockage. If no blockage is found, the best treatment is to instruct the patient to perform self-catheterization a few times a day. By emptying the bladder regularly the incontinence disappears and the kidneys are protected.
Says Dr. Johnson: "There is more money spent on controlling and dealing with incontinence - on purchases such as pads and protective underwear - than on all women's cancer care. With help from the medical community, the public could become much more aware of how common - and how treatable - this condition is." See any of our urologists at UANT, they can discuss this and several other issues with you and guide you to the Center for Urinary Control, if necessary and start living life to the fullest once again.
For more patient education on Incontinence & Symptoms
Tracy W. Cannon-Smith, M.D.
Marie-Blanche Tchetgen, M.D.
James Daniel Johnson, M.D.
Keith R. Xavier, M.D.
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