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Urinary Incontinence

Urinary incontinence is the accidental loss or leakage of urine. It is very common in both men and woman. Many of people affected by incontinence do not discuss it, despite the fact that it affects their daily activities and lives. Urinary incontinence can be managed or treated effectively.

SYMPTOMS:

Urinary incontinence is the accidental loss or leakage of urine. It is very common in both men and woman. Many of people affected by incontinence do not discuss it, despite the fact that it affects their daily activities and lives. Urinary incontinence can be managed or treated effectively.

RISK FACTORS:

  • Childbirth, pregnancy and menopause
  • BPH
  • Neurological damage/disease
  • Bladder stones
  • Bladder Cancer
  • UTI
  • Constipation
  • Side effects of medications

EVALUATION & DIAGNOSIS:

After speaking with your practitioner, some of the following tests may be ordered:

  • Urine culture
  • Urine flow
  • Cystoscopy
  • Urodynamic testing
  • Ultrasound

TREATMENT:

The treatment of incontinence depends on the type of incontinence and gender.

Stress Incontinence

Injectables: uses an injecting material e.g. collagen, fat, to increase the bulk around the urethra to improve the function of the urethral sphincter and compress the urethra near the bladder outlet.

Biofeedback/Pelvic floor therapy: Where electrodes are placed on bladder/pelvic floor muscle and hooked up to a computer to show the activity in real time. A trainer/therapist then evaluates the patient and takes the patient through exercises designed specifically to exercise the correct muscle. 

Kegel Exercise: uses a tightening and relaxing of the sphincter muscle to promote strengthening of the pelvic floor.

Hormone replacement therapy (HRT): uses estrogen and progestin medication to restore the health of the urethral tissue in postmenopausal women.

Percutaneous Sling/Transvaginal Sling: use a strip of tissue or synthetic material to create sufficient urethral compression to achieve bladder control

Urge Incontinence

Medications: use anticholinergic and other agents to relax smooth muscle tissue and have an antispasmodic effect on overactive bladder.  

Bladder retraining: a voiding diary is kept of all episodes of urination and leaking and is then analyzed for a pattern of urination. This timetable is used to plan when to empty the bladder to avoid accidental leakage.

"Bladder Pacemaker" or Interstim: nerve modulation with implanted electrodes. 

Percutaneous Tibial Nerve Stimulation (PTNS): Through an "acupuncture" type needle placed in the ankle electrical stimulation is administered to modulate bladder behavior.

Bladder Augmentation: a surgery performed to increase the capacity of the bladder by adding bowel segments or reducing the muscle-squeezing ability of the bladder.

Overflow Incontinence  

Usually caused by either bladder outlet obstruction and/or weak bladder muscle. If there's any bladder outlet obstruction then that becomes the focus of treatment. The treatment of overflow incontinence is complete emptying of the bladder.  

Medications: use alpha-1-andrenergic blocking agents to relax striated and smooth muscle, decreasing urethral resistance and relieving symptoms. 

Intermittent Self-Catheterization: uses a catheter to drain the bladder every 3 to 8 hours to keep urine volumes low.