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| Urinary Incontinence |
Urinary incontinence has recently gained considerable attention in the United States. It is estimated that approximately 10 to 20 million people (10-35% of the U.S. population) are suffering from urinary incontinence. 50 percent of the institutionalized elderly are incontinent.
The estimated cost of diagnosis and treatment of this group is 15 billion dollars per year. Though these numbers are staggering, about half of incontinent patients do not alert their physician or family members of their problem. Unfortunately, most of these individuals assume nothing can be done for incontinence or feel that leakage is a normal part of aging.
Urinary incontinence is defined as the involuntary loss of urine from the bladder. It is important to remember that not all incontinence is the same. There are several types of incontinence:
-
- stress incontinence
- urge incontinence
- mixed incontinence
- overflow incontinence and
- functional incontinence
Correct diagnosis of the type of incontinence is the first and most important step in designing an appropriate and effective treatment plan for incontinence.
| Stress incontinence |
Stress incontinence is the most common type of leakage
encountered and is most associated with bladder leakage. Stress incontinence
is the loss of urine that occurs with any maneuver that increases intra-abdominal
pressure, such as coughing, sneezing, lifting, laughing, intercourse,
or changing position.
This typically occurs in women that experience loss of support in the
anterior vaginal wall leading to dropping of the bladder neck and urethra
during increases in abdominal pressure. Most investigators feel that
the descent of the bladder neck and urethra out of the normal intra-abdominal
position into the pelvis prevents closure of these structures during
times when pressure is exerted on the bladder body. Some feel that the
change in the angle of the bladder neck and urethra are responsible for
the leakage. Stress incontinence can occur in men as well, but is most
often seen following trans-urethral prostate surgery or surgery for prostate
cancer.
| Urge incontinence |
Leakage that occurs when there is a
sudden uncontrollable need to urinate is urge incontinence. This most
often occurs in those people with spinal cord injuries, multiple sclerosis,
strokes, or diseases of the spinal cord.
This may occur also in male patients with an obstructing prostate or
in women with loss of estrogen effects to the vaginal wall, bladder and
urethra. Bladder muscle in many of these patients is overactive and usually
provides very little warning to the patient that urination is eminent.
Occasionally, in elderly patients, this bladder overactivity is accompanied
by decreased bladder contractions, leaving these patients with incompletely
emptied bladders. This syndrome is called detrusor hyperactivity with
impaired contractility.
| Overflow incontinence |
Overflow incontinence occurs when the bladder is inefficiently emptied, leaving large amounts of urine in the bladder. As the volume increases, the resistance provided by the bladder, neck and urethra may be overcome, and urine loss may occur. This pattern is common in diabetics, male patients with enlarged prostates, urethral structures and in some patients with spinal cord injuries. In some cases this may be caused by medications taken for other conditions.
| Functional incontinence |
Functional incontinence is common in disabled or demented
patients and is the most common type of incontinence in the nursing home
setting. Patients with functional incontinence have normal orderly bladder
activity but are unable to respond to this signal, due to immobility
or impaired mental functioning. As a consequence, they become incontinent
unless they are prompted to void or asked void on a schedule.
Evaluation of the incontinent patient will focus on categorizing the
type of incontinence being experienced. With this understanding, specific
therapy can be recommended that is individualized to each patient.
| Treatment for Incontinence |
If you are struggling with incontinence, it does
not have to become a way of life for you. There are exercises you can
do, and the latest surgical procedures can virtually "cure" this
embarrassing problem. These surgical procedures include collagen injections
and the transvaginal sling procedure. If you are struggling with incontinence,
see a urologist to determine the best treatment alternative for you.
Remember—you're in control!
The most common type of incontinence, stress incontinence, is caused
by weakened pelvic muscles. Pelvic muscles are not exercised regularly,
which causes them to be naturally weak. Also, pelvic muscles can be weakened
even more in the process of childbearing. During a vaginal childbirth,
the child passes underneath the pelvic floor muscle. This weakens the
pelvic muscle and can lead to incontinence.
There are many treatments available for incontinence. One easy way to
improve your continence is by doing pelvic floor muscle exercises. Your
pelvic muscle stretches from your front pubic bone to your tailbone in
the back. This muscle supports the bladder, large intestine and the uterus.
The exercise can strengthen the pelvic muscle to decrease incontinence.
Incontinence is decreased because the exercise strengthens the pelvic
muscle and the urethra, the tube from which the urine flows. Strengthening
the urethra enables it to stay closed during stressful activities like
aerobics or a tennis match.
If the exercises are done regularly, they will strengthen the pelvic
muscles. To do them, you simply pretend that you are trying to stop the
flow of urine you are voiding. You can actually stop your urine stream
while you are urinating to get the hang of the exercise, but do not do
it often because it will cause harm.
Collagen Injections
The collagen injection is typically an outpatient procedure. The doctor will insert a cystoscope, like a telescope into your urethra to locate the areas where the collagen should be injected. A needle then comes out of the cystoscope and injects the collagen into these areas.
After the collagen injection, most patients do not have any incontinence, and others will have a significant reduction in urine leakage. Because some of the collagen will be absorbed by the body, you may have to have more collagen injections after a few years. Before you have the procedure done, you should have the doctor inject a small amount of the collagen into your skin to determine if you have an allergic reaction to the collagen.
Transvaginal Sling
When a more permanent method of incontinence relief is
needed, a transvaginal sling is created to support the bladder neck,
urethra and sphincter to provide aid in urine leakage. The doctor takes
a tool and inserts it into the vagina. Two anchors will be placed into
the pubic bone with this tool. Then, the doctor makes a "sling" out
of a biocompatible synthetic material like gortex or he may use some
of your own tissue. The sling is secured by the anchors, and it supports
the bladder, bladder neck, urethra and sphincter.
The sling procedure is a more permanent way to "cure" female
incontinence. Recovery for this procedure is a little more complex than
the collagen injection. The transvaginal sling procedure usually requires
the insertion of a catherter for a limited amount of time, usually 24
hours, and you must refrain from lifting objects heavier than 10 pounds
for a month. However, the long-term gain from the surgery is worth it.
The Urology Clinics of North Texas have performed over 150 of these transvaginal
sling procedures. Of these surgeries, 85 percent of them were done on
a same-day surgery basis. None of the procedures required the patient
staying overnight. The average time for the surgery averaged around 32
minutes.
You're in Control
The Urology Clinics of North Texas has developed a program for individuals experiencing urinary incontinence. To learn more about the program, call 214-691-1902.
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