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Incontinence

Overview

Incontinence

Urinary incontinence, or uncontrolled urine loss, is more common than most people think. In fact, more than 17 million Americans have urinary incontinence, with more than 80 percent of incontinence cases occurring in women. But, urinary incontinence is not a normal process of aging and can occur in women and 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 such as birthing procedures, pelvic surgery, hysterectomy and multiple abdominal surgeries; 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 or activity that weakens the pelvic floor.

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. Stress incontinence can result from childbirth or certain surgeries and exercises that weaken the pelvic floor.
  • 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, lack of estrogen, 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 treatedand, 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. The most common medicine prescribed for stress incontinence is estrogen, which is most effective in postmenopausal women. Medications for other types of incontinence include Flomax, Hytrin and even Botox.
  • Biofeedback, or special exercises and training programs, can be helpful and effective in treating incontinence and improving bladder control. Certain exercises, known as Kegel exercises, strengthen the sphincter and pelvic floor. These exercises must be done correctly and consistently in order to be effective. 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 can be approached in one of three ways: through the lower abdomen, through the vagina or by injecting a liquid “bulking agent” around the urethra.
    • 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 through the vagina, or “sling surgery,” is performed by making a vaginal incision and placing a strip of tissue, or “sling,” either above or beside the urethra. The sling provides support for the urethra and sphincter muscles and adds compression to the urethra. Sling surgery can be performed on an outpatient basis with less recovery time. It is currently the most frequently performed surgery for stress incontinence. Surgery through the abdomen and through the vagina have excellent results, with 85 percent of patients being dry after five to 10 years.
    • 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 InterStimis 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. 
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