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Incontinence

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Night time Incontinence (Nocturnal enuresis)

At around four or five years old, most children gain control of urine at night. However, bedwetting may still occur in 15% of children six years old. This can occur for a variety of reasons, including increased urine production while asleep, inability to store enough urine through the night and unstable bladder contractions. Bedwetting will usually subside at a rate of 10% per year as children grow towards adolescence. During this period of time, there are treatments that we can provide to help control the problem. It is best managed with a combination of behavioral changes (decreasing fluid intake later in the day, controlling for underlying constipation, and use of a “bed alarm”) in conjunctions with medications (DDAVP and/or imipramine).  The good news is that patients will invariably grow out of this condition and that there is rarely a serious underlying problem.  

Mixed Incontinence

Sometimes both stress incontinence and urgency incontinence can occur together.  Your doctor will work to figure out the best approach to evaluation and management of your condition.  Often a combination of behavioral modification, medications, and surgery will be used together to provide you with relief.  Sometimes additional evaluation with urodynamics (studies that evaluate for storage capacity, bladder muscle function, and urethral sphincter function) and cystoscopy (a lighted scope that evaluates the lining of the bladder and urethra) may be necessary to further understand your voiding dysfunction.

Urgency Incontinence

Urge incontinence is the inability to control the sudden urge to urinate. It involves an uncontrolled bladder contraction and it may occur after a sudden change in position or activity.

Treatment for urinary incontinence varies for each patient, based on type and severity. Our physicians will work with you to determine which treatment option best fits your lifestyle and needs. Below are some common treatment options that our physicians will discuss with you at length.

 

Non-Invasive Treatments

Behavioral Modifications

Lifestyle or behavioral modifications are usually the first therapy our physicians recommend, and it may be the only treatment necessary. The modifications include:

  • Pelvic muscle exercises (Kegel's exercises)
  • Reducing fluid intake
  • Changing or eliminating medications
  • In mild forms of leakage, urinary sanitary pads/undergarments can help with the discomfort and embarassment of incontinence

 

 Medications

  • The same medications that offer benefit in urinary urgency and frequency can offer improvement of leakage of urine due to an unstable bladder.

 

Sacral Nerve Stimulation

After a test procedure to confirm benefit, a small neurostimulator is implanted to help regulate unstable bladder contractions or help emptying of the bladder. This is an outpatient procedure with a short time to recovery.

 

Botulinum Toxin

Botulinum toxin (Botox) may be injected into the bladder wall to control the overactive bladder muscle. This is mainly used in patients with neurological conditions which lead to unstable bladders.

Stress Incontinence (SUI)

This includes the involuntary loss of urine during certain physical activities, including coughing, laughing, and lifting. It is caused by a weak or damaged sphincter, the muscle that holds back urine.

Treatment for urinary incontinence varies for each patient, based on type and severity. Our physicians will work with you to determine which treatment option best fits your lifestyle and needs. Below are some common treatment options that our physicians will discuss with you at length.

 

Non-Invasive Treatments

 

Behavioral Modifications

Lifestyle or behavioral modifications are usually the first therapy our physicians recommend, and it may be the only treatment necessary. The modifications include:

  • Pelvic muscle exercises (Kegel's exercises)
  • Reducing fluid intake
  • Changing or eliminating medications

 

Medications

Unfortunately there are currently no available medications that are effective at treating SUI.

 

Procedural Management

 

Bulking Agents

Bulking agents can be used to treat stress incontinence. A bulking material is injected into the tissue surrounding the urethra to help bring the urethral lining together. This is an outpatient procedure.

 

Suburethral Slings

Composed of a synthetic mesh, suburethral slings act as a hammock under the urethra, compressing it to prevent leaks that occur with daily living.  This is an outpatient surgery with a short time to recovery.

 

 Pessary

In women with pelvic prolapse contributing to incontinence and who are not fit for or would prefer to avoid surgery, this special device is inserted in the vagina to hold up the bladder and may help with leakage by helping the patient empty her bladder more effectively.

 

Pelvic Prolapse Surgery

Surgery performed to restore the bladder and bowel to normal position in women who have pelvic floor weakening.

 

Male Sling

Similar to a sling procedure performed in a woman, a piece of synthetic mesh can be placed through a small incision to help compress the urethra in men who suffer post procedure stress incontinence (usually after prostatectomy). This is very effective for mild stress urinary incontinence in men.

 

Artificial Urinary Sphincter (AUS)

In men who have more severe stress urinary incontinence, the artificial sphincter is very effective at controlling leakage. It involves a cuff that puts pressure around the urethra until a patient desires to void. A small valve in the scrotum is activated by the patient, and this relieves the pressure around the urethra. It is completely concealed, reliable, and has excellent patient satisfaction. As with the male sling, urethral obstruction must be ruled out prior to placement.

Urinary Incontinence

Urinary incontinence is the loss of bladder control, meaning the loss of urine when you do not expect or intend it.

 

Millions of adults in the United States have urinary incontinence. It is more common in people older than 50 years of age, especially women, but many men also suffer from incontinence.

 

Types of Incontinence

 

Stress

This includes the involuntary loss of urine during certain physical activities, including coughing, laughing, and lifting. It is caused by a weak or damaged sphincter, the muscle that holds back urine.

Urge

Urge incontinence is the inability to control the sudden urge to urinate. It involves an uncontrolled bladder contraction and it may occur after a sudden change in position or activity.

Mixed

This is a combination of stress and urge incontinence. It is not uncommon for patients to experience more than one type of incontinence.

Overflow

When the bladder is not emptying normally and fills well beyond its normal capacity, the pressure of urine in the bladder may overwhelm the sphincter's ability to hold back urine. Often patients are surprised to learn that their bladder is so full because they do not feel the urge to urinate.

 

Risk Factors

Below are common risk factors for urinary incontinence.

  • Childbirth
  • Pelvic injury
  • Prostate surgery, mainly prostatectomy
  • Old age
  • Urinary infection
  • Diseases such as diabetes, Alzheimer's disease, multiple sclerosis and diabetes
 

Treatment Options

For more information on our treatment options for urinary incontinence, click here.