TOPICS

Urinary Incontinence

Urinary Incontinence is the involuntary loss of urine that is sufficient to be a problem. It is estimated that approximately 13 million Americans suffer from urinary incontinence. It occurs in both men and women, but is more common in women. It is believed that 25% of all women between the ages of 39 and 59 experience episodes of urinary incontinence. Urinary incontinence also affects at least 50% of the homebound elderly and is one of the leading causes of institutionalization of the elderly. Despite the prevalence and cost burden of the condition, most individuals with urinary incontinence do not seek help for their condition, opting for a lifestyle of worry and potential embarrassment. The truth is, whether you are 45 and dealing with stress incontinence, or 85 and dealing with functional incontinence, most cases of incontinence are manageable through exercise, medication, or surgery.

What are the different types of incontinence?

There are four types of chronic urinary incontinence; stress incontinence, urge incontinence, overflow incontinence, and functional incontinence

Stress Incontinence: This is the most common type of urinary incontinence in women. Stress incontinence usually occurs when the vaginal and pelvic floor muscles stretch after childbirth, weight gain, surgery, or lowered estrogen levels due to menopause. The stretching causes the neck of the bladder to sag and the bladder neck is not able to stay closed when abdominal pressure increase. This is why many women experience urine leakage when they cough, laugh, sneeze, or participate in strenuous physical activity.

Urge Incontinence: This type of incontinence is defined as the inability to hold urine long enough to reach a toilet. There is a strong and sudden urge to urinate followed by an involuntary loss of urine. Urge incontinence affects both men and women. People who suffer from urge incontinence say the need to urinate comes with little warning at any time of day or night. The ability to delay emptying the bladder is reduced or lost with urge incontinence. Apparently, as the bladder ages, urge incontinence may occur and may get worse. A healthy person has a series of warnings or messages that the bladder is full and can postpone voiding until a socially acceptable time is found

Overflow Incontinence: In this type of incontinence the bladder is unable to empty completely. A relatively large amount of urine is left in the bladder after urinating and may overflow causing leakage. Diseases such as diabetes or spinal cord injuries and physical problems such as a sagging bladder may lead to overflow incontinence.

Functional Incontinence: In this type of incontinence there is some type of chronic impairment, either physically or mentally. People who suffer from functional incontinence usually have some type of disability that causes them to be unable to completely empty their bladder, or postpone emptying their bladder when they have the urge to urinate.

Symptoms of Urinary Incontinence

• Urine leakage when laughing, coughing, sneezing, or during physical exertion
• Urgency (difficulty postponing urination)
• Frequent urination
• Nocturia (getting up at night to urinate)
• A feeling that the bladder is not completely emptied after urination
• Straining during urination
• Constipation

Diagnosing Urinary Incontinence

Initially your urologist will want to talk with you about your past medical history especially any information about your symptoms. Your urologist will probably need to do some diagnostic testing to determine the cause of your problem. Once this has been determined you and your urologist can work together to find the treatment that is best for you.

Treating Urinary Incontinence

The treatment of urinary incontinence depends on the type of incontinence and the lifestyle of the patient. Many patients can be treated with a combination of exercise and lifestyle changes. Other patients may require medication and some patients will benefit most from surgery.

Exercises and lifestyle changes: Kegel exercises strengthen the pelvic floor muscles that support the bladder. In mild cases, their success rate is up to 60%. Two to three sets of Kegels should be performed every hour each day for at least two to three months to be effective. Your doctor can give you information on how to correctly perform Kegel exercises.

There are a few lifestyle changes that can help improve urinary incontinence. Practicing healthy toilet habits like taking the time to completely empty your bladder and not straining when urinating can help. Maintain an adequate fluid intake. Try to drink at least 6 to 8 large glasses of fluid per day unless otherwise advised by your doctor. And try to maintain an ideal body weight. Extra weight can increase abdominal pressure on your bladder and place an extra burden on your pelvic floor muscles.

Medication: Estrogen supplements can improve the thickness and tone of the pelvic muscles and vagina. In about 35% of cases, estrogen supplements may be enough to relieve the symptoms.

Surgery: For a more long-term solution, surgery may be the best answer. Although there are many different types of surgery being performed, clinical studies report that the most effective technique for stress incontinence is the Burch Bladder Suspension. This procedure is now being done laproscopically and on an outpatient basis.

Urethral Stricture

Urethral stricture is an abnormal narrowing of the tube that carries urine out of the body from the bladder (urethra). Causes include inflammation or scar tissue from surgery, disease, or injury. Common risk factors include:

• A history of sexually transmitted disease (STD)
• Instrumentation of the urethra such as a catheter or cystoscope
• Benign prostatic hyperplasia (BPH)
• Trauma to the pelvic area
• Repeated episodes of urethritis

Symptoms

• Blood in the urine
• Difficulty urinating
• Frequent urination
• Painful urination
• Spraying of the urinary stream
• Discharge from the urethra

Diagnosis includes a detailed history and physical including onset of symptoms and severity. Your doctor may also choose to evaluate your urethra with a variety of office tests including

• Post-void residual volume: determining how well you empty your bladder
• Urinary flow rate: strength of urinary stream
• Retrograde urethrogram: x-ray performed while instilling dye into urethra
• Cystoscopy: looking into urethra and bladder with a small telescope

Treatment

Various treatment options exist, each with their own advantages and disadvantages.

• Urethral dilation: gently stretching the stricture with sequential dilators. Usually performed in the office with local anesthesia, however recurrence rate is high.
• Endoscopic Incision: the stricture is cut using a special cystoscope while under general anesthesia in the operating room. Typically performed on outpatient basis, and no formal skin incision is needed. Success rate is typically pretty good, but depends on location of the stricture and length of the stricture. Each subsequent incision carries higher recurrence rate.
• Open urethroplasty: removing the diseased segment and replacing with healthy tissue. The technique used depends on location and length of the stricture, as well as surgeon experience. For longer strictures, a tissue graft is usually needed to bridge the gap. The tissue used for grafting can include local penile skin or even buccal mucosa from inside the cheek. Success rates are typically very good with low recurrence rates, especially with surgeons with experience in performing these procedures.