Urinary incontinence is the loss of control of the bladder that causes leaking of urine..This can occur as the result of aging and the changes that occur in the pelvic area. Often occurs in women after having children.
To correctly diagnose your incontinence, pay attention to the activities, situations and conditions that cause difficulty controlling your bladder. This will help your doctor determine the type of incontinence you suffer from. You may be asked to keep a “voiding diary” to keep track of fluid intake and bladder activity and share it with your urologist to aid diagnosis and treatment.
Some or all of the following tests may be recommended to ensure accurate diagnosis:
• Urinalysis to check for infections or the presence of blood.
• Residual urine measurement will determine if any urine is left in the bladder after urinating.
• Cytoscopy is a direct visualization of the inside of the bladder
• Stress test is done by asking the patient to cough or bear down and visually checking for incontinence or displacement of pelvic structures.
• Urodynamic testing is done to measure bladder muscle tone, capacity and nerve conduction.
Several medications are used to treat incontinence. Medications used to treat overactive bladder work by relaxing the bladder muscle and making it less sensitive. These medications work very well to help reduce or eliminate symptoms of urge incontinence. The most common medicine prescribed for stress incontinence is estrogen. Medications for other types of incontinence include Flomax, Hytrin and even Botox.
• Biofeedback, or special exercises and training programs, can be helpful and effective in treating incontinence and improving bladder control. Certain exercises, known as Kegel exercises, strengthen the sphincter and pelvic floor.
o Surgery is an option for patients who have not been helped by biofeedback and/or medication or who are not candidates for those treatments.
o Surgery through the vagina, or “sling surgery,” is performed by making a vaginal incision and placing a strip of tissue, or “sling,” either above or beside the urethra. The sling provides support for the urethra and sphincter muscles and adds compression to the urethra. Sling surgery can be performed on an outpatient basis with less recovery time. It is currently the most frequently performed surgery for stress incontinence.
o Surgery using “bulking agents” does not require an incision. A thick liquid compound is injected around the urethra to compress and close the urethral channel. The advantage of this procedure is that there is only a 24-hour period of limited activity required following the surgery.
o Another surgical procedure called sacral nerve stimulation with InterStim is also an option for incontinence patients. This is a minimally invasive procedure in which a neurostimulator is implanted over the hip and used to reprogram the nerves that control the bladder. This procedure has been shown to correct or significantly improve urge incontinence in 70 percent to 80 percent of patients who have failed other treatments.