Urinary Incontinence


Urinary incontinence simply means leaking urine. Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder. Incontinence is a very common problem, but is not a part of aging. If you have this problem, you do not have to "just live with it." There are treatments and things you can do on your own to stop or reduce urine leakage.

Types of Incontinence

Urinary incontinence in women can be divided into three main types:

  1. Stress urinary incontinence (SUI) is leaking urine when coughing, laughing, or sneezing. Leaks also can happen when a woman walks, runs, or exercises.
  2. Urgency urinary incontinence is a sudden strong urge to urinate that is hard to stop. Women with this type of urinary incontinence may leak urine on the way to the bathroom. If you have an “overactive bladder” (OAB), it means that you have symptoms of urgency and frequency that may or may not include incontinence.
  3. Mixed incontinence combines symptoms of both SUI and urgency urinary incontinence.

Visiting Your Doctor

If you believe you have urinary incontinence, your doctor or nurse can find out what might be causing your incontinence. He or she can also suggest ways to relieve the problem. When you speak to your doctor or nurse, ask if any of the medications you take could be causing your symptoms. some medicines can cause incontinence or make it worse.

Treatment of Incontinence

Incontinence is treated based on what type of incontinence you have, and whether you are a man or a woman. Your gynecologist or other health care professional may first recommend nonsurgical treatment. This may include lifestyle changes, bladder training, physical therapy, and using certain bladder support devices. For urgency urinary incontinence, the treatment may involve medication. Surgery may help certain types of incontinence. Often, several treatments are used together for the best effect.

Urodynamics

Urodynamics refers to to a series of diagnostic tests that evaluate the function of the bladder and urethra. These tests may be recommended if you have urinary incontinence (leakage of urine), recurrent bladder infections, slow or weak urinary stream, incomplete bladder emptying, or frequent urination. These tests help the clinician understand the 2 S's and 3 C's of Urodynamics: Sensitivity, Stability, Compliance, Capacity, and Competence.

Sensitivity

"Often I feel like I have to go again, right after I just went!"

During the procedure your bladder will be filled with sterile water. You will be asked about various urinary sensations and desires you might be feeling during this stage. The results will help better diagnose the overall sensitivity or your bladder such as, does your bladder feel full when it actually is full, does your bladder feel empty after voiding, and other various bladder sensations.

Stability

"Doctor I have to go several times during the night, and when I go it's not very much."

Your bladder can perform interesting acts, and one is most often referred to as an overactive bladder. This is similar to a muscle spasm equivalent to an eye twitch. During the filling stage the clinician will monitor the muscle in your bladder for over-activity. The muscle called the detrusor is the muscle that can perform this "twitching" activity, resulting in several unnecessary trips to the restroom or even leakage called urge incontinence.

Compliance

"I seem like I go to the bathroom 7-8 times a day regardless of what I drink. I must have a very small bladder."

Your bladder is constructed of striated elastic muscles. When your bladder is filling, it expands to accommodate the urine and later contracts when emptying. The catheter placed in your bladder will constantly measure your pressure to ensure that they stay within optimum levels.

Capacity

"I drink half a glass of milk and I have to go to the bathroom, and I go all the time."

Bladder capacity is an important part of determining the results of Urodynamic testing. The amount of fluid needed to fill your bladder can help determine the elasticity and overall bladder health. Should you be asked to complete a voiding diary, it is important to accurately record voiding times and amounts.

Competence

"When I cough with a bad cold, run upstairs, or even lift a heavy bag of groceries I leak. Sometimes I have to push on my belly to completely empty."

Your bladder has the ability to expand when filling,, properly store urine, and contract to empty. Incomplete voiding can be caused by several issues, and most importantly can be easily assessed by Urodynamics. You might even be instructed to cough heavily in efforts to reproduce urinary leakage identifying leak point pressures for additional diagnosis and/or treatment.

Urdoynamic Testing Procedures

At the beginning of the test you will be asked to urinate, so please arrive for the study with a relatively full bladder. The Uroflow test measures the speed and amount of urine you void. You will be asked to urinate into a commode with a funnel attached to a computer that measures your urine flow. Next, catheters used to measure bladder and abdominal pressure are placed near the rectum to record muscle activity. This tests measures how well you can control your sphincter (outlet) muscles and determines if they are working in coordination with your bladder. The CMG/Pressure-Flow study evaluates how your bladder holds urine, measures your bladder capacity, and also determines how well you can control your bladder. Through a catheter your bladder is filled with fluid. In order to reproduce your bladder symptoms, you should report any sensations you feel during the study. In addition, you may be asked to cough, bear down, stand or walk in place during the test. At the end of the study you will be asked to urinate.

The Use and Care of Pessaries

A pessary is a vaginal prosthesis used to effectively relieve the stress of cystocele, a rectocele, a uterine or bladder prolapse, or the problems associated with urinary incontinence. Pessaries come in various shapes, sizes, and materials. They are perfectly safe and comfortable for long term usage.

Common Uses of Pessaries

  • To improve or restore continence.
  • For diagnosis to determine is surgery is necessary.
  • To delay or prelude surgery.
  • As an alternative to surgery.
  • To manage uterine prolapse and vaginal wall hernias.
  • To relieve a cystocele (bladder prolapse) or a rectocele.
  • To relieve lower back pain caused by retroversion.
  • Diagnosis and therapy in obstetrics.
  • To prevent miscarriage by relieving pressure on a weak cervix.

Care of Pessaries

  • Cleaning Your Pessary—It is recommended that you remove your pessary everyday to clean is using mild soap and water. If you have difficulty removing you pessary, contact your healthcare provider and make an appointment for removal and cleaning.
  • If Your Pessary has Moved Out of Position and/or is Uncomfortable—Wash your hands, lie down and push the pessary up as far as you can. Don't worry, it can't get lost. it's impossible to push your pessary into your abdomen.
  • If You Experience Discharge and/or Bleeding—Sometimes pessaries can irritate the body tissue causing a slight discharge or bleeding. Call your healthcare provider if it persists.
  • If Your Pessary Falls Out—If your pessary is too small or you need a different type of pessary, sometimes it will fall out. Whenever this happens, simply clean your pessary with mild soap and water and reinsert it. If it is a persistent problem, then call your healthcare provider for an appointment. You may need a different size or type.

Overactive Bladder

An overactive bladder causes a sudden need to urinate. This can be difficult to stop and can lead to involuntary loss of urine (incontinence). An overactive bladder can affect your day-to-day life and emotions. However, you can get help — a brief evaluation can determine if there is a cause for your overactive bladder symptoms. Treatments such as pelvic floor muscle exercises, medications, and nerve stimulation can reduce or eliminate symptoms.