Imagine that your daughter is about to receive her college diploma when the feeling of urgency strikes. You squirm uncomfortably in your seat, torn between two concerns: you don’t want to go to the restroom and miss her big moment, but you fear the accident that will likely occur if you stay seated. As the pressure increases, you’re forced to dash to the bathroom just as the announcer calls her name. Another special moment is tarnished by urinary incontinence.
Urinary incontinence affects the lives of millions of people, regardless of age or gender. “Anyone can develop it”, notes Andrew Shapiro, MD, Director of the Chesapeake Urology Center for Continence and Pelvic Floor Disorders. Women tend to develop it more often than men do. However, men who have undergone prostate surgery, sustained spinal cord injuries, neurological injuries or strokes are at high risk as well. Urinary incontinence has three primary forms, stress, urge and overflow incontinence. These differ in symptoms, causes, as well as the type of person who suffers from these issues.
Stress incontinence frequently affects women, especially after childbirth. In addition, men who have undergone prostate surgery are also at risk. Stress incontinence is leakage caused by coughing, sneezing or any activity that puts stress on the abdominal muscles. Stress incontinence typically occurs during the daytime but in people with severe leakage, it may occur both day and night. The problem is normally worse when the bladder is full or partially full.
Urge incontinence is a common problem that affects both men and women. It becomes increasingly common as people age. Men and women with neurologic issues, such as Diabetes, Multiple Sclerosis, Parkinsons or major back issues, are far more likely to have this issue. People with urge incontinence experience a sudden and strong desire to urinate. This desire cannot be postponed and often leads to incontinence episodes. People with this condition will also go more frequently and may wake up at night to urinate. Urge incontinence can be triggered by several factors, including dietary irritants, urinary tract infections and nervous system damage. Sometimes, especially in elderly patients, this condition can lead to falls and even admission to a nursing home.
Although women tend to experience incontinence more frequently than men, overflow incontinence is predominantly a male condition. “As the male ages and his prostate enlarges, it can block his bladder. This in turn makes it difficult to empty the bladder. When men’s bladders no longer have the strength to empty well, they begin to leave large amounts of urine behind after they urinate. This can lead to “overflow” incontinence. Sufferers frequently complain of an inability to void, despite a constant feeling of the need to empty the bladder, and often experience urine leakage.
Incontinence can be diagnosed by talking to the man or woman suffering these symptoms. Normally, a good history, physical examination and a urinalysis will give us the necessary information to diagnose the problem and begin treatment. For people who have more complicated histories, have had prior pelvic surgery or who have failed conservative treatment, we rely upon office testing to give us more specifics.
Dr. Shapiro relies on two primary examinations to diagnose the specific type of urinary incontinence, a urodynamic test and a cystoscopy. The urodynamic test bears many similarities to an EKG and assesses bladder function. The test is done in the office and allows us to determine why people are having problems with their bladder. The second diagnostic measure is a cystoscopy, in which a tiny camera is inserted into the urethra to look inside the bladder and examine the lining for any blockages or abnormalities that may explain the symptoms.
The treatment options for urinary incontinence vary widely based on the patient’s needs and the form of incontinence that affects them. “In general, doctors like to begin with the most conservative treatment and move to procedures only when necessary,” Dr. Shapiro explains. For patients suffering from stress incontinence, the first line of treatment is pelvic floor physical therapy.
“Pelvic floor muscle exercises help increase muscle tone and the overall strength of the pelvic floor muscles,” Dr. Shapiro notes. Physical therapy is a non-invasive treatment that can be quite effective but does require time and patience as the improvement typically occurs over the course of months.
Women with stress incontinence may also benefit from an outpatient suburethral sling procedure, in which a physician places a piece of permanent mesh beneath the urethra to help re-support the weakened urethra. This procedure is minimally invasive and takes less than a half-hour to complete. It is an outpatient procedure with excellent success rates.
For women who desire an office based procedure or who are poor candidates for a sling, injectable therapy can be used. We can inject an agent which helps to seal the weakened urethra. This therapy is less invasive and can be safely done in the office. While it is not as permanent as a sling, it can be effective for the right candidate.
Men with stress incontinence can also be treated with injectables or slings. Male stress incontinence is far less common and is almost always related to a prostate procedure. For men with more severe leakage, an artificial sphincter may be necessary.
Urge incontinence is associated with bladder irritability and spasticity. Oral medications (pills) are often effective in reducing these symptoms. There are multiple options available and not one pill works for everyone. For men and women who do not get adequate improvement from medication, we have several other minimally invasive options. Interstim is a very effective procedure for men and women who have failed medications and dietary changes. Interstim is an implant which is like a bladder pacemaker. Thru a simple office test, we can tell whether or not you are a candidate for this therapy. This test is easy to perform with minimal risk and after 1 week we will know whether or not this therapy is suite for you, Dr. Shapiro explains. Another potential option would be injecting medication directly into your bladder.
Overflow incontinence is most frequently due to an enlarged prostate. For many men, this can be fixed with an outpatient laser procedure to open up the obstruction. This is done thru a camera inserted into the urethra. It is typically performed as an outpatient with you sedated. The improvement is generally seen immediately and the procedure is generally safe.
Although urinary incontinence is a frustrating and embarrassing condition, many times it can be treated easily and successfully. “Women who have stress urinary incontinence have a greater than 90 percent chance of having a significant improvement or cure with sling surgery. Patients who have urge incontinence may see significant improvement from medication or minimally invasive surgery. Sadly, this very treatable condition is often either too embarrassing or people are unaware that it is treatable and they do not seek help. Dr. Shapiro recommends several outside resources to individuals struggling with urinary incontinence, including:
• The National Association for Continence (www.nafc.org)
• The American Urological Association (www.auanet.org)
Incontinence is a widespread condition that touches millions of lives, but some simple steps can be taken to reduce your chances of developing bladder control problems. There are ways to avoid or improve your control problems at home. We know that caffeine can worsen bladder symptoms. Therefore, minimizing or avoiding coffee, tea, soda and alcohol can improve your urgency. Losing weight is also very helpful in reducing your risk of developing incontinence, according to recent studies exploring the effects of weight on urinary incontinence. In addition, Kegel exercises can help improve or prevent stress incontinence. These exercises are often difficult to teach yourselves and a trained physical therapist can be very helpful for those patients who are unsure. Toning your pelvic floor, eating a healthy diet, exercising and maintaining a healthy weight can all be important factors in preventing or improving incontinence — which means that your special moments will no longer be interrupted!!
For more information or for an interview with Dr. Shapiro, please call CUA PR at 443-738-8107.
This entry was posted on Friday, April 9th, 2010 at 8:13 am and is filed under Patient Resources. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.
