Urinary Incontinence
Urinary incontinence is the uncontrolled leakage of urine. This problem afects more than 25 million Americans, both men and women, and children as well as the elderly. Urinary incontinence is classified by doctors in three types:
-
Stress incontinence is the incontinence related to increased pressure in the abdomen. Abdominal pressure may rise due to coughing, sneezing or exercising.
-
Urge Incontinence occurs in patients who have a strong, uncontrollable urge to urinate that leads to uncontrollable voiding of urine.
-
Overflow incontinence is the incontinence occurring after urinary retention.
In some patients incontinence is due to a combination of these three types.
Causes of Urinary Incontinence
Urinary incontinence may be caused by one or more of the following reasons:
-
Weakness of muscles of urinary bladder or pelvic floor.
-
Urinary tract infections.
-
Childbirth.
-
Injury in pelvic region.
-
Birth defects.
-
Blockage of urethra.
-
Brain or spinal cord injuries.
Factors that lead to bladder control problems have not only to do with how many babies have you had or how big was the baby's head. Bladder problems run in the family! We are not all blessed with the same structures. Just as eye sight is very different from one person to another or one family to another, so it is with bladder problems. We tend to have similar anatomical structures to our parents and family members so it is not unusual to find the same patterns of problems in other members of the family.
There are many causes of incontinence and sometimes leakage is caused by problems "outside of the bladder". The bladder needs space to be able to fill and hold. When the bladder space is crowded by other organs in the pelvis, there will be symptoms of increased frequency and urinary leakage. It is not enough to consider causes for leakage in the bladder alone; you must evaluate the whole pelvis.
Bowel function will be an important cause for bladder symptoms. When the bowels are full, bladder control is not as good. Patients often make bladder problems worse by trying to avoid drinking liquids. When the body is dry, more fluids are drawn out of the colon and the stools become hard and more difficult to move. Regulating your fluid intake and taking a healthy diet and walking exercise will help to solve some bladder problems.
Can Emory help me if I have urinary incontinence?
Yes, Emory University has the expertise to help a patient with urinary incontinence. A typical evaluation would include:
Complete urological check up, including history and voiding diary (keeping track of when you void and how much each time)
Physical examination
Review of medical records from previous surgery or treatments
Urodynamics might be recommended to further study the lower urinary system.
Once the evaluation is completed, a treatment plan is detailed.
Will exercises help control my leakage?
Yes. Pelvic floor muscles are weaker in patients with bladder control problems. These muscles can be strengthened by exercises or stimulation treatments. We have developed a new therapy that uses a magnetic field to strengthen pelvic floor muscles and correct leakage problems. This technology was developed at Georgia Tech and pioneered by the doctors at Emory. This treatment (ExMI) is very successful in correcting problems of bladder control and is now being used in 37 countries worldwide. For treatment, the patient sits fully clothed on a special chair. Each treatment session takes 20 minutes, and most patients will attend twice a week for 6-8 weeks for the best results. To learn more about ExMI please visit: http://www.neotonus.com/urology_gynecology/index.htm
What about surgery to correct my incontinence problem?
Surgery can also be performed in patients who don't respond to medical treatment. For some patients, leakage is due to anatomical problems, that is to say something has been damaged or torn away from its normal place. The bladder rests on the vagina and when the vagina is detached or pulled away from its normal place in the pelvis, the bladder will come away with it. This can cause urinary leakage and a bulge in the vagina. Symptoms of incontinence (stress incontinence) are often worse with lifting or coughing. When the bladder "comes down" it can be difficult to empty properly. As the structures move out of place in the vagina, the bowel will often be displaced and there will be difficulty with bowel movements or bowel control. It is important to include all of these structures in assessment. If surgery is necessary to correct these problems it is critical that all of the anatomical problems are corrected for best results. It is rarely necessary to consider hysterectomy in the surgical treatment of incontinence and vaginal prolapse.
What is neuro-modulation therapy?
Some bladder symptoms are due to problems of coordination or neuromuscular control. Neuro-modulation therapy is a specific type of therapy used when incontinence is due to such disturbances of neuromuscular control. In this type of therapy, a pacemaker, similar to the one used for heart, is implanted in the body to regulate the activity of nerves to the bladder and pelvic floor. This therapy is used to treat urge incontinence, symptoms of frequency and urgency, and also for problems of non-obstructed urinary retention or incomplete emptying. For details please visit: http://www.medtronic.com/patients/bladder.html
Measures to help improve continence
-
Avoid overuse of diuretics, antidepressants, and cough-cold preparations.
-
Practice double emptying of urinary bladder (urinate, wait a few seconds, urinate again).
-
Avoid constipation.
-
Avoid smoking.
-
Retrain the bladder by passing urine every 3-6 hours only.
Protective devices to manage wetting of clothes
Many products are available for use as protection against uncontrolled passing of urine. Some of them are available commercially at grocery stores. Some are available at your local pharmacy or medical supply stores. If you find that you are purchasing these products, you should discuss your incontinence with your doctor.
|
