| EASTSIDE UROLOGY |
| ASSOCIATES |
|
|
| Physicians | Eastside Urology Clinic | Eastside Urology Ambulatory Surgery Center | Urology Links | Directions | Home |
|
URINARY INCONTINENCE
Urinary incontinence is the involuntary loss of urine and poses is a significant problem in the U.S. The prevalence of urinary incontinence in women ranges from 10-40%. In 2000, there were an estimated 17 million adults with urinary incontinence and an estimated 34 million suffering from overactive bladder. Incontinence may be classified as urge incontinence, stress incontinence or a mixture of the two. In recent years, there has been significant medical and surgical progress with managing incontinence. Urge Incontinence Urge incontinence, also referred to as overactive bladder, is the involuntary loss of urine accompanied by or preceded by a sensation of urgency. Urge incontinence has a reported prevalence of 16.0% in men and 16.9% in women. There are various causes, including dietary factors (caffeine, alcohol), medications, urinary tract infections, and medical conditions such as diabetes, stroke and multiple sclerosis. In addition, women who are post-menopausal may suffer from hormone related changes of the vagina which cause the tissues to weaken and become irritated. Often, the sensation of urgency with resulting leakage of urine has no identifiable cause, and thus is known as idiopathic urge incontinence. Prior to starting treatment for urge incontinence, the doctor will evaluate you by several methods. These include a detailed history and physical exam, evaluation of current medications, and a voiding diary. The voiding diary (downloadable here) will help you keep track of how much fluid you are taking in, the type and amount of leakage you are having, and the activity associated with each episode, thus helping to establish the type and severity of your incontinence. In addition to these studies, laboratory work including urinalysis and kidney function tests may be obtained. Further studies include a detailed pelvic examination, examination of the inside of the bladder using a small telescope (cystoscopy), and urodynamics. In addition, your doctor may perform imaging studies such as CT scan or ultrasound as determined by the results of these initial studies. Once these studies have been completed and the results evaluated, several treatment options may be discussed. There are several nonsurgical options that you may take to reduce the urgency and leakage. These include dietary modifications such as removing caffeine and alcohol from the diet, fluid restriction at night to reduce the number of nighttime voids, and bladder retraining exercises. Behavioral modification is directed at improving voluntary control of bladder function to decrease urgency and may result in improvement rates in incontinence episodes in excess of 50%. Pelvic floor muscle training has also been reported to help improve symptoms associated with bladder over activity. Biofeedback with or without electrical stimulation has shown subjective improvement in patients with urge incontinence. One study produced subjective improvement in 51.4% of patients treated with electrical stimulation and 50% of those using biofeedback-assisted pelvic floor muscle training. Medications may be added to behavioral and dietary modifications to help with urgency and urge incontinence. These medications include but are not limited to Oxybutynin (Ditropan®, Ditropan XL®), Tolterodine (Detrol®, Detrol LA ®), Solifenacin (VESIcare®), Trospium (Sanctura®), and Darifenacin (Enablex®). These medications work by decreasing involuntary bladder contractions. Contraindications to using these medications include narrow-angle glaucoma, urinary or gastric retention, myasthenia gravis, ulcerative colitis, or other obstructive gastrointestinal tract disease. The most common side effects are dry mouth and constipation. Other less common side effects include abdominal upset, nausea, diarrhea, urinary retention, vertigo, blurred vision, drowsiness, headache and dry eyes. If medications fail, minimally invasive surgical procedures may be considered. These include implanting a small device that stimulates the sacral nerve, which is the nerve that controls bladder contractions. This device, called Interstim®, is used to regulate bladder contractions. For more information, please visit the website, or ask your doctor. Another option available for the treatment of urgency and urge incontinence is the injection of botulinum toxin A (Botox®) directly into the muscle of the bladder. When injected into detrusor muscle, it produces a localized chemical denervation to the muscle, essentially paralyzing portions of the bladder wall and decreasing involuntary bladder contractions. This can be done through a small telescope in the bladder cystoscopy as an outpatient. For more information, please contact our office. Stress Incontinence Stress urinary incontinence is involuntary loss of urine associated with exertion, sneezing, coughing or laughing. It is very common in women, and can occur in association with urgency and urge incontinence (mixed urinary incontinence). Stress incontinence may be caused by pelvic floor trauma associated with childbirth, previous urethral or pelvic surgery, neurologic medical conditions, pelvic trauma or pelvic radiation. Similar to urge incontinence, the management of stress incontinence begins with a thorough evaluation. This includes a detailed history and physical exam, evaluation of current medications and a voiding diary. The voiding diary will help you keep track of how much fluid you are taking in, the type and amount of leakage you are having, and the activity associated with each episode, thus helping to establish the type and severity of your incontinence. In addition to these studies, laboratory work including urinalysis and kidney function tests may be obtained. Further studies include a detailed pelvic examination, examination of the inside of the bladder using a small telescope cystoscopy, and urodynamics. In addition, your doctor may perform imaging studies such as CT scan or ultrasound as determined by the results of these initial studies. Once these studies have been completed and the results evaluated, several treatment options may be discussed. Some options include pelvic floor muscle training or "Kegels." These exercises increase the strength, bulk, and function of the pelvic floor/levator muscles. They may be performed at home or with a physical therapist, and may include use of vaginal cones or weights, biofeedback or electrical stimulation. If pelvic floor muscle training does not improve stress incontinence completely, there are a variety of minimally invasive surgical options available. These include the suburethral sling procedure in which a small piece of mesh is placed beneath the urethra which provides a hammock-like support to the urethra. This increases the support needed during times of increased abdominal pressure, such as coughing, running, laughing or sneezing. There are a variety of sling procedures being performed today, including trans-obturator, suprapubic, transvaginal and autologous slings. The majority of these are performed through the vagina through a small incision, and patients go home either the same or next day. Another procedure that may be performed for the treatment of stress incontinence is an injection of a material such as collagen or carbon coated beads (Durasphere™) into the urethra. These periurethral bulking agents increase the tissue bulk around the urethra. This increases the resistance to the outflow of urine. This procedure may be performed in the ambulatory surgical center, and patients go home the same day. For more information regarding these procedures, please contact our office. If a prolapse of the bladder or vagina is noted in association with the leakage, a device such as a pessary may be inserted to gently push the vagina into the correct anatomic position. This may also be accomplished with a surgical procedure to restore the normal vaginal anatomy. Urinary incontinence is quite common in both men women of all ages, and there many options for its evaluation and treatment. For more information, or to schedule an appointment, please contact our office at 425-899-5800. |
|
