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Urinary incontinence is defined as the involuntary loss of urine or bladder control. It affects millions of Americans, both men and women. Unfortunately many men and women believe incontinence is a natural effect of aging and do not feel that treatment is available. Urinary incontinence is not a disease, but rather is a symptom due to an underlying problem that can almost always be treated. There are many types of urinary incontinence, and different underlying causes for each type. The impact of the problem in one’s life cannot be underestimated. The chance of embarrassment, limitations to travel and social engagement as well as loss of productivity represent only a part of the difficulties patients experience with this problem.
At Comprehensive Urology medical group, our team works with our patients in order to create a tailored program to help address their specific problem.
Symptoms
There are different types of urinary incontinence:
Stress Incontinence – Leakage occurs with strong pressure transmitted through the abdomen and pelvis, often from straining, coughing, laughing or sneezing.
Urge Incontinence - Leakage occurs due to involuntary contractions of the bladder muscle. It is also termed “overactive bladder”.
Mixed Urinary Incontinence – Leakage due to a combination of the above
Overflow Incontinence – Leakage occurs due to an overflow of urine from a full bladder
Causes
There are many causes of incontinence which include:
- Infection and inflammation
- Anatomic variations due to childbirth or surgery
- Neuromuscular dysfunction due to stroke, spinal cord injury, diabetes or other underlying disease
- Benign prostatic hypertrophy (an enlarged prostate)
At Comprehensive Urology, we believe that a proper and thorough evaluation is the first step to understanding the cause of the problem.
Evaluation
Our team first begins with a thorough history and physical examination. Even with all of our advanced diagnostic techniques, this time honored tradition often is the most important tool in identifying the cause of our patient’s symptoms. When we take the time to listen to your story, the nature of the problem and sometimes, more importantly, the personal context becomes obvious. A voiding diary is often employed to document the extent of leakage and context in which it occurs.
Diagnostic Studies
A careful examination of the urine and laboratory values are used to help assist with the diagnosis of the underlying cause of incontinence. Other studies that can assist with the diagnosis may include pelvic ultrasound, post void residual examination, cystoscopy, and urodynamic studies. These studies can help our physicians better understand the relationships between the urinary bladder and surrounding tissues.
Treatment
Fortunately there are many therapies available to treat urinary incontinence. Our physicians work with each patient to help determine their optimal treatment program.
These therapies include medications, non-pharmacologic approaches, as well as surgical procedures.
Medications
Multiple medications are available and help manage different types of urinary incontinence and associated symptoms. They must be balanced against the risk of side effect or interactions with other necessary medications. With careful consideration of each individual’s need, an appropriate medicine can be selected and implemented with scheduled follow up to evaluate results.
Non-Pharmacologic Approaches
For some patients, medications may not be the right solution due to side effects or medication interactions, or they may need further assistance with their symptoms.
One of the specialized programs that we offer at Comprehensive Urology is Pelvic floor rehabilitation therapy. Regular sessions with our doctors and therapists have yielded excellent results often in patients who have not benefited from other types of therapy. We monitor the progress of each patient during their sessions, and often the therapies can be taught to patients to perform themselves outside the office. In addition, diet and lifestyle changes with behavioral modification may assist in treatment.
Another specialized treatment that we offer at Comprehensive Urology Medical Group is Peripheral Nerve Stimulation. This new and novel therapy is painless, has no side effects, and has been extremely effective in managing irritative urinary symptoms in patients who have often not been able to find relief with other treatments.
Surgical Approaches
Many men and women who suffer from urinary incontinence may benefit from minimally invasive surgical treatments to assist with their symptoms. Our physicians perform a variety of pelvic and urethral support procedures that are customized to each patient. For women, trans-vaginal, and trans-obturator slings, for example can be placed in an outpatient setting.
For men experiencing difficulties after surgeries or radiation, several male sling options exist or an artificial urinary sphincter may be implanted.
Endoscopic injections can serve to curb leakage in many settings and are very well tolerated with local anesthetic and a sedative.
In certain cases, sacral neuromodulation or nerve stimulator implants can be used to electrically stimulate the bladder nerve roots and improve voiding or stop leakage.
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