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Live Life Dry: Treating Urinary Incontinence

It would be difficult to watch an hour of prime time television today without seeing an advertisement for overactive bladder medication or adult diapers. The fact is more than 37 million adults in the United states-one in six-suffers from overactive bladder, urinary frequency, or urgency. Unfortunately, many people dismiss such urinary symptoms to be a part of “getting older” and do not seek medical intervention. The fact is, overactive bladder and urinary retention (the inability to completely empty the bladder) are not a normal part of the aging process, can cause embarrassment, and can diminish the quality of daily living dramatically.

Facts

Women are twice as likely as men to experience urinary incontinence. This is due to pregnancy, childbirth, menopause and the structure of the female urinary tract. Older women experience urinary incontinence more often than younger women. Bladder control problems may also affect younger people, especially women who have just given birth. In fact, a recent study found 25 percent of women over 18 years old has experienced episodes of leaking urine involuntarily, and one-third of men have experienced loss of bladder control during their adult lives. Only one in eight Americans who have experienced loss of bladder control have been diagnosed. Recent data has shown that women wait and average of 6.5 years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problems. People experiencing bladder control issues often suffer diminished social lives. Even mild symptoms affect social, sexual, interpersonal and professional function. People with bladder control problems often struggle with simple everyday activities, such as working, shopping, or seeing a movie, for fear of embarrassing wetting episodes or not being near a restroom. Also, overactive bladder sufferers are two to three times more likely to regularly experience disturbed sleep, overeating, and poor selfesteem.

Diagnosis

Bladder control issues can be caused by a multitude of factors. In certain cases, pregnancy and childbirth, obesity, weak pelvic muscles or diabetes can contribute to overactive bladder. Additionally, certain medications or inactivity also can contribute to such issues. In some people, bladder control problems are caused by miscommunication between nerves. Specifically, the brain and sacral nerves, which control the bladder, do not communicate properly, causing the nerves to tell the bladder to release urine at the wrong time. The first step towards treatment is diagnosing the type of incontinence and then pinpointing the underlying cause or causes. We ask our patients to complete a “voiding diary” which provides great insight and aids in diagnosis. The gold standard for diagnosing urinary issues, including incontinence, is called Urodynamic testing or Urodynamic study. This series of tests, all done in one visit, along with the data from your voiding
diary will give the physician objective data related to bladder functions. Additionally, physicians often perform a cystoscopy to further assess the urinary tract. A cystoscopy is a test that allows the doctor to look at the inside of the bladder and the urethra using a thin, lighted instrument called a cystoscope. This study helps find the cause of symptoms such as blood in the urine (hematuria), painful urination (dysuria), urinary incontinence, urinary frequency or hesitancy, an inability to pass urine (retention), or a sudden and overwhelming need to urinate (urgency) and much more.

Treatment

In some instances, behavior modification may be sufficient to deal with urinary incontinence. You may be asked to limit fluid intake, avoid bladder irritants such as a caffeine and alcohol, and do pelvic floor exercises-“Kegels”. There are also medications commonly used to treat overactive bladder (OAB) and are sometimes prescribed to treat stress urinary incontinence. In certain cases of incontinence involving the miscommunication of nerves to the bladder, a neurostimulator (commonly called a Bladder Pacemaker) may be the best treatment option. Incontinence is not a hopeless problem. There are many treatment options available, however, only proper diagnosis will lead to proper treatment. Although behavior modification and pharmaceutical therapy work for some, they may be ineffective or poorly tolerated by other patients. It is definitely possible to live life dry.

Types of Incontinence

  • Stress Urinary Incontinence (SUI) – Leakage on effort, exertion, sneezing or coughing.
  • Urge Incontinence – Leakeage accompanied by or preceded by urgency (an overwhelming need to urinate… “Gotta go, gotta go!”)
  • Mixed Incontinence – Leakage associated with urgency AND effort, exertion, sneezing or coughing.