Incontinence

Bladder control problems range from urinating too frequently to actual urine leakage (or incontinence). These problems affect millions of men and women of all ages. Unfortunately, many people feel embarrassed by this problem and often don’t seek help. Today, there are a number of treatment options available to both manage and resolve incontinence problems. After a thorough workup, our experienced urologists offer a wide variety of options to help you resume a normal life.

Types

  • Urge Incontinence (Overactive Bladder) - in this type, urine leaks when the bladder inappropriately contracts and doesn’t allow enough time for you to make it to the bathroom
  • Stress Incontinence - this type occurs during any activity that may put excess pressure on the bladder such as sneezing, coughing, laughing, heavy lifting, and exercising.
  • Overflow Incontinence - in this type, the bladder actually isn’t emptying properly causing small amounts of urine to continuously leak out as bladder capacity is met.
  • Functional Incontinence – this type occurs when patients simply can’t get to the bathroom in time due to physical condition (e.g. disabled, poor mobility, bed ridden, dementia)

Causes

Since there are several types of incontinence, the underlying cause may include one or more of the following:

  • Diet high in bladder irritants such as coffee, tea, chocolate or acidic fruit juices
  • Urinary tract or vaginal infections
  • Bowel problems (e.g. constipation, irritable bowel, diverticular disease)
  • Damage to the nervous system (e.g. Multiple Sclerosis, Parkinson's disease, Alzheimer's)
  • Childbirth or pregnancy
  • Menopause
  • Vaginal or bladder prolapse
  • Prior surgery (especially pelvic or prostate)
  • Prior pelvic radiation
  • BPH / Enlarged prostate
  • Lower back problems
  • Side effect from medication

Diagnosis

Following a thorough history and physical examination, your doctor may order additional imaging and lab tests including:

  • Urine analysis / Urine culture
  • Bladder scan for post void residual (PVR) volume
  • Voiding diary
  • Blood tests
  • Imaging (ultrasound, CT, MRI)
  • Urodynamics
  • Cystoscopy

Treatment

As there are several types of incontinence, your individual treatment plan may vary. Initially, your doctor will start with less invasive options such as behavioral changes or medication. For cases that don’t respond to those treatments, other procedures may be offered such as nerve stimulation or surgery. Blockages usually must be treated surgically; however, those caused by prostate enlargement may be treated with medication.

Lifestyle Changes

  • Fluid and diet management
  • Bladder retraining / Timed voids
  • Pelvic floor (Kegel) exercises
  • Biofeedback
  • Special absorbent pads and underwear

Medications

  • Anticholinergics – relax the bladder by limiting sudden contractures
  • Beta Agonist – allows the bladder muscle to stretch, thus increasing capacity
  • DDAVP - decreases the amount of urine made (less commonly used)
  • Botox – relaxes the bladder to minimize sudden contractures

Non-surgical Devices

  • Tibial Nerve Stimulation (TNS/Urgent PC) – small electrical stimulator is temporarily placed behind the ankle bone to stimulate nerves that lead to bladder relaxation.
  • Sacral Nerve Stimulation (Interstim) – initially done on a one week trial basis in which temporary wires are placed into the lower back to stimulate nerves that lead to bladder relaxation. If improvement is found, your doctor may recommend a permanent implant to regain bladder control.
  • Pessaries - a woman with stress incontinence caused by prolapse can have a pessary (rubber ring) inserted into the vagina to reduce leakage

Surgery and Implanted Devices

  • Bulking agent - for stress incontinence only. Using a cystoscope, a thick substance is injected into the area around the bladder / urethra to help support it.
  • Sacral Nerve Stimulation (Interstim) – after a successful trial period, a small “bladder pacemaker” is implanted in the upper buttock area
  • Mid-urethral Sling – this is a minimally invasive surgery in which a synthetic material or a piece of your own tissue is used to support the urethra. This is used in both male and female incontinence.
  • Retropubic suspension - your surgeon attaches the bladder to structures behind the pubic bone to provide more support. This is often referred to as a “bladder lift”.
  • Artificial Urinary Sphincter (AUS) - for men with incontinence typically following a prior treatment for prostate cancer. A small cuff is placed around the urethra that is controlled by a small bulb placed into the scrotum. This allows the patient to control the timing and flow of urine.
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