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Bladder Health

Incontinence

Urinary incontinence, or uncontrolled urine loss, is more common than most people think. In fact, more than 17 million Americans have urinary incontinence. But urinary incontinence is not a normal process of aging and can occur in men of all ages.

Under normal conditions, the bladder stores urine until it is voluntarily released. This involves a complex interaction between the brain, spinal cord and bladder. Anything that interferes with this interaction can make a person incontinent.

Incontinence is not life-threatening, but it does have negative social implications. You may lose your self-esteem and experience depression, anxiety and feelings of helplessness. Your fear of urine loss may become an obsession. You may lose your sense of sexuality. You may distance yourself from friends and loved ones or limit social interaction outside the home. The good news is that incontinence can typically be corrected or improved to the point that it no longer interferes with daily activities.

Education/General Information

Anything that interferes with the normal processes of the urinary system can cause incontinence. Factors contributing to incontinence include medical conditions such as urinary tract infections, diabetes, arthritis, Parkinson’s disease and Alzheimer’s; surgical problems; medications such as cold and hay-fever medications, certain high blood pressure medications, pain medications, muscle relaxants and medications for depression and/or anxiety; certain exercises such as high-impact aerobics; or any injury to the nerves that control the bladder.

There are five different types of urinary incontinence. The most common types are stress, urge and mixed incontinence.

  • Stress incontinence is urine leakage caused by coughing, sneezing, exercising, lifting or strenuous activity.
  • Urge incontinence occurs when people experience sudden, overwhelming urges to urinate and often feel that they cannot wait to reach the bathroom. Urge incontinence can be the result of urinary tract infections, diabetes, Parkinson’s disease, Alzheimer’s disease, prior bladder surgery, medication or injury to the nerves that control the bladder. Urge incontinence also can develop without any apparent cause.
  • Mixed incontinence is a combination of both stress and urge. The cause of both forms may or may not be related.

Less common forms of incontinence are functional and overflow incontinence.

  • Functional incontinence occurs in people who are unable or unwilling to use a toilet. Severe illness, arthritis and confusion can all lead to functional incontinence.
  • Overflow incontinence is when the bladder is never empty after urination, even though it may feel as if it is. Because the bladder does not completely empty, excess urine can spill out. Certain diseases, surgical procedures and medications that lead to other types of incontinence can also lead to overflow.

Diagnosis

To correctly diagnose your incontinence, pay attention to the activities, situations and conditions that cause difficulty controlling your bladder. This will help your doctor determine the type of incontinence you suffer from. You should also keep a “voiding diary” to keep track of fluid intake and bladder activity and share it with your physician to improve diagnosis and treatment.

Some or all of the following tests may be recommended to ensure accurate diagnosis:

  • Urinalysis
  • Residual urine measurement
  • Cytoscopy
  • Stress test
  • Urodynamic testing

Treatment

Incontinence is not a life-threatening problem, but it can be a social problem. Thankfully, incontinence can be treated and, in most cases, corrected or improved so that it is no longer a health and social problem. Incontinence can be treated in one of three ways:

  • Numerous medications have been developed in the past 10 years to treat incontinence, and these developments have significantly improved the treatment process. Many of these medications can decrease and even eliminate the uncontrolled loss of urine in patients. Medications used to treat overactive bladder work by relaxing the bladder muscle and making it less sensitive. These medications include Detrol, Ditropan, Urispas, Levsin, Bentyl and Tofranil.
  • Biofeedback, or special exercises and training programs, can be helpful and effective in treating incontinence and improving bladder control. Gradually prolonging the time between visits to the toilet, known as bladder retraining, can also be effective when coupled with reasonable fluid intake. Eliminating foods and liquids such as caffeine, alcohol and spicy foods, which can irritate the bladder muscle, may decrease symptoms.
  • Surgery is an option for patients who have not been helped by biofeedback and/or medication or who are not candidates for those treatments.
    • Surgery through an incision in the lower abdomen is effective for correcting stress incontinence. However, the recovery time can be quite long, requiring six to eight weeks of limited activity following the procedure. In the past 10 years, this procedure has been performed more and more using a laparoscope, which lessens the recovery time.
    • Surgery using “bulking agents” does not require an incision. A thick liquid compound is injected around the urethra to compress and close the urethral channel. The advantage of this procedure is that there is only a 24-hour period of limited activity required following the surgery. However, the disadvantage is that the effects generally last for only one month to one year.
    • Another surgical procedure called sacral nerve stimulation with InterStim is also an option for incontinence patients. This is a minimally invasive procedure in which a neurostimulator is implanted over the hip and used to reprogram the nerves that control the bladder. This procedure has been shown to correct or significantly improve urge incontinence in 70 percent to 80 percent of patients who have failed other treatments.

Overactive Bladder

Overactive bladder is a type of bladder-control problem that affects more than 33 million Americans of all ages. It occurs when the detrusor muscle of the bladder contracts more often than necessary, even when the bladder is not full. This constant contraction causes sudden, overwhelming urges to urinate.

Though overactive bladder is a common medical condition, many patients may feel ashamed or embarrassed to discuss it. However, it is important to communicate with your doctor about your overactive bladder so it can be properly treated. It is not a normal part of aging. Overactive bladder can be treated with medication, behavior modification and changes in diet. In rare cases in which these treatments do not work or cannot be used, another treatment called sacral nerve stimulation with Interstim is available.

Educational/General Information

The common symptoms of overactive bladder are frequency (the need to urinate often), urgency (the sudden, uncontrollable need to urinate), nocturia (the need to urinate often at night) and urge incontinence, or wetting accidents. You may feel as if you can’t wait to reach a toilet and you may lose urine on the way. At times, you may leak urine without any warning at all. Patients with overactive bladder feel the need to urinate extremely often. They often have sudden, uncontrollable needs to urinate, even at night.

A bladder can become overactive because of infection that irritates the bladder lining. The nerves that normally control the bladder can also be responsible for an overactive bladder. Other causes can include drug side effects, neurological disease or stroke. Overactive bladder may also be associated with bladder cancer, urinary tract infections and enlarged prostate. In other cases, the cause may be unclear. Risk factors include aging, obstruction of urine flow, inconsistent emptying of the bladder and a diet high in bladder irritants, such as coffee, tea, cola, chocolate and acidic fruit juices.

Diagnosis

To get a diagnosis of overactive bladder, your doctor starts with a complete health history to learn about other urinary conditions you’ve had in the past and when the problem started. Questions your doctor may ask about your overactive bladder include:

  • How often do you urinate?
  • How often do you leak urine, and how severely?
  • Do you feel any pain or discomfort while urinating?
  • For how long has the urge or urinary incontinence been occurring?
  • What medications are you taking?
  • Have you had any recent surgery or illnesses?

Keeping a voiding diary at home can help you answer these questions and help with an overactive bladder diagnosis. Each day, write down how much you drink, when you urinate, how much you urinate each time, and whether you ever feel an urgent need to go.

Your doctor will then examine your abdomen, genitals and rectum. You might also be given a neurological exam to look for problems in your nervous system that could affect your ability to urinate.

There are also a number of tests that may be performed to diagnose overactive bladder, including:

  • Urinalysis or urine sample
  • Bladder stress test to find out if you are leaking urine
  • Cystoscopy to look for cysts and growths in the bladder
  • Urodynamic testing
  • Voiding cystourethrogram to identify structural problems in the bladder and urethra

These tests can help diagnose whether your condition has something to do with an infection or other illness, a blockage or poorly functioning bladder muscles. Knowing the cause of your overactive bladder can help your doctor decide on the right treatment for you.

Treatment

There are many options for the treatment of overactive bladder:

  • Behavior modification consists of techniques that help strengthen and train pelvic muscles. Behavior modification techniques include bladder training and biofeedback. Bladder training, which can help control wetting accidents as well as frequency and urgency, consists of instruction about normal and abnormal urination and scheduling of urination.
  • Medication is prescribed either in conjunction with behavior modification or after behavior modification has been tried unsuccessfully. The drugs most commonly prescribed by doctors to treat overactive bladder are Detrol-LA and Ditropan-XL. These drugs, also known as anticholinergic drugs or antispasmodics, prevent involuntary contractions of the bladder muscle by relaxing and stabilizing the muscle. Another medication called Tofranil, most often used for depression, can also help by calming the bladder.
  • Doctors often recommend that overactive bladder patients limit their intake of caffeine and alcohol, which can irritate the bladder.
  • Some people do not benefit from or cannot tolerate behavior modification or medications. For these people, sacral nerve stimulation with InterStim is an available treatment option. This is a procedure in which a neurostimulator device is inserted under the skin, near a nerve that affects bladder function, and sends electrical pulses to the sacral nerve. The sacral nerve affects bladder control muscles, and stimulation of this nerve can help improve overactive bladder. After the device is implanted, it can run for five to 10 years
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