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Urinary incontinence is the involuntary loss of bladder control leading to urine leakage.
What Are The Characteristics and Symptoms of Urinary Incontinence?
Urge incontinence is the most common type of incontinence. This is also known as an “overactive bladder.” It occurs when you suddenly feel as though you need to urinate, but cannot reach the bathroom in time. There can be many different causes of an overactive bladder.
Stress incontinence happens when there is a sudden increase in pressure (stress) in the intraabdominal area (and thus increased pressure on the bladder) caused by laughing, coughing, sneezing, exercising, or heavy lifting. It is essentially a weakness of the pelvic floor muscles.
Mixed incontinence is a combination of stress and urge incontinence.
Overflow incontinence occurs when the bladder cannot empty properly. Because the bladder never empties completely, it may feel full again very quickly. Some people may have periodic leaking without any sensation of fullness. Overflow incontinence cannot be diagnosed by these symptoms alone and tests must be performed.
Functional incontinence occurs when a person has difficulty getting to the bathroom due to illness, arthritis or the environment. This type of incontinence is uncommon and can only be established as a cause after other possibilities have been ruled out by a physician.
Who Is Most Likely To Have Urinary Incontinence?
You may be at risk for urinary incontinence if:
- You are a female who has recently undergone pregnancy and/or childbirth.
- You are postmenopausal and have hormonal imbalances which can contribute to weakening of the pelvic floor muscles.
- You are a male who has had a prostatectomy, BPH (benign prostatic hyperplasia), or prostate cancer.
- You have had a UTI (urinary tract infection) or interstitial cystitis (inflamed bladder wall)
- You have had multiple sclerosis, Alzheimer's, or Parkinson's Disease.
- You have had tumors or cancer in the uterus, bladder, or prostate
Treatment Options for Urinary Incontinence:
Behavioral Modification
Simple lifestyle or behavioral modifications are often the first therapy, and may be the only necessary treatment. These include modifying the diet, reducing liquids before bedtime, or eliminating or adding medications.
Behavioral therapy relies on biofeedback to increase the patient's awareness of the lower urinary tract, to strengthen the muscles that control the bladder. Pelvic floor muscle exercises, also known as Kegel exercises, strengthen the muscles around the urethra so that urine is less likely to leak, even under pressure. Over half of women who leak urine do so in part because they are unable to use these muscles to stop their leakage. For patients with difficulty identifying and strengthening their pelvic floor muscles, some specialists use biofeedback and electrostimulation devices as training aids. These therapies require time, effort and commitment, but they do not have side effects and are often very effective.
Medication Treatment:
Several medications, e.g. Ditropan, treat incontinence by:
- preventing unwanted bladder contractions
- tightening the bladder or urethra muscles
- relaxing bladder muscles.
Sometimes these drugs can cause dry mouth, vision problems or urinary retention.
Injectable Treatments:
Bulking agents are mainly used to treat stress incontinence in men and women. collagen or other materials can be injected into the tissue around the urethra to add bulk and keep the sphincter muscles closed to stop urine from leaking. The procedure is conducted on an outpatient basis at with local anesthesia or sedatives. A needle is inserted through the urethra and the bulking agent is injected into the area around the bladder neck to tighten it.
collagen is one bulking agent used. A natural animal substance similar to fat, it begins to break down after several months, requiring repeat injections every four to 12 months. Newer substances, such as water-based gels, are also being used in the hope that they will provide longer-lasting results. Clinical trials of new bulking agents are also being conducted.
Many specialists report that many patients see significant improvement in their condition following the injection. Most patients return to normal activity within a day of two following the procedure.
Botulinum toxin (Botox) is sometimes injected into the muscles of the bladder to treat incontinence. Botox blocks the release of chemicals which cause muscle spasms. The injection is given under anesthesia and is effective for nine months to a year. It is not an FDA-approved treatment, so is not usually covered by insurance.
Interventional Devices
Various devices can be used to treat urinary incontinence. They include:
- Pessary - a special device inserted in the vagina to hold up the bladder and prevent leakage
- Bladder neck support device - a prosthesis inserted in the vagina to elevate the bladder neck and restore the normal anatomic relationship between the bladder and urethra. This device is fitted by a physician and inserted and removed daily by the patient.
- Urethral insert - A small plug that is inserted into the urethra, and removed for urination.
- Urine seal - a small disposable foam pad that is placed over the urethra opening. This device is removed for urination and thrown away.
- Artificial urinary sphincter (men) - A tiny, doughnut-shaped device is inserted under the skin of the penis to close the urethra. By pressing a valve implanted under the skin, the artificial sphincter can be inflated to stop urine and deflated to allow urination.
Surgery to Correct Urinary Incontinence
What Does The Surgery Involve?
When other options fail, surgery is an excellent choice for treatment of urinary incontinence. It is sometimes required to remove blockages, improve the bladder neck position, add permanent bulk to tissues, or to add support to weakened pelvic muscles.
Pubovaginal Fascial Slings
Pubovaginal fascial slings are a highly successful option for women with incontinence. In this operation, the urologist attaches a piece of fascia (flat, tough, tendonlike material -- about 1 in. wide and 5 in. long) around the bladder neck to keep urine in, even under stress.
This surgery require two incisions: one through the vagina (approximately 2 inches) and one in the abdomen. For autologous slings, the abdominal incision is approximately 8 inches, while the cadaveric incision is less than an inch long.
Suburethral Slings
This is an outpatient, minimally invasive form of sling surgery with a high rate of success. Instead of using human tissue to form the sling, suburethral slings are made of a synthetic mesh. The sling is placed under the urethra, where it acts as a hammock, compressing the urethra to prevent leaks that occur with activities of daily living. This procedure is less invasive (requires a smaller incision, resulting in less pain), has a faster recovery time and has the same rate of success as the pubovaginal sling surgery.
Sacral Nerve Stimulation
Sacral nerve stimulation is an FDA-approved electronic stimulation therapy which can be effective in reducing urge incontinence. A thin lead wire with a small electrode tip is surgically placed near the sacral nerve (in the lower spine), which controls voiding function. A nerve stimulator sends small electrical impulses continuously to the sacral nerve. The impulses act as a bladder pacemaker, reducing or eliminating urge incontinence in a high percentage of patients.
Enlarging the Bladder
Using a segment of intestine to enlarge the size of the bladder, this surgery can cure incontinence. However, in up to 30 percent of cases, patients may need a catheter.
Laparoscopic Surgery
Some procedures can be done using an endoscope (laparoscopically). These procedures are used to surgically remove urinary tract obstructions, such as kidney stones and enlarged prostate glands. The endoscope is a small, flexible tube with an attached optical system that is inserted into the body through the urethra or a small incision. The optical system allows physicians to see inside the body and perform surgery by inserting and manipulating equipment through the tube.
What Are The Advantages Of Surgery for Urinary Incontinence?
When urinary incontinence is refractory to other treatments, surgery provides a more permanent correction to the problem.
How Long Does It Take?
This is dependent on the individual treatment option chosen. Consult your physician.
How Many Treatments Are Required?
Usually, for surgery, one treatment is sufficient.
When Will I See Results?
You should start to see results after a reasonable healing period from surgery is complete.
What Are My Alternatives for Treating My Urinary Incontinence?
The alternatives to surgery have been described above. The first line of treatment options is usually behavioral modification and lifestyle changes.
Will I Have Pain?
Anesthetic is used during the procedure, so pain should be not be a major issue. As the anesthetic wears off, there may be slight post-operative pain.
When Can I Go Back To Work Or School?
You may return to work or school usually within 1-2 weeks after the procedure.
Who Will Perform My Urinary Incontinence Treatment?
The surgery will be performed by one of our highly-trained specialists in the field.
How Much Does It Cost?
Depends on prescribed procedure. Please call TopSurgeons at 800-506-8084 for more information.
Will My Insurance Cover Treatment for Urinary Incontinence?
Most insurance companies will cover these procedures.
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