Urinary incontinence is defined as uncontrollable loss of urine. Urinary incontinence is not a normal consequence of aging and childbirth and with early evaluation and appropriate treatment in most cases can be treated and controlled. Continence is maintained by a combination of structural, muscular, and nervous system coordination that if disrupted can lead to urinary incontinence.
It was not long ago that any woman who complained of urinary incontinence would be taken to the operating room for a variety of surgical treatments including an anterior and posterior repair to abdominal operations that were less than effective with significant short-term and long-term complications. At last count, 135 procedures for incontinence have been recorded. Over the past 25 years, significant advances in diagnosis and treatment of urinary incontinence have been made. Our goal with each patient is to identify the etiology of incontinence and design a treatment plan that meets her continence profile.
THESE FOLLOWING CONDITIONS CAN OCCUR TOGETHER IN THE SAME INDIVIDUAL AND SYMPTOMS MAY NOT DIRECTLY POINT TO THE CONDITION CAUSING A PATIENT’S INCONTINENCE.
Most Common Types of Urinary Incontinence
Stress incontinence loss of urine on exertion or when pressure is exerted on the bladder, ie: coughing, laughing, sneezing, exercise, jumping, In this condition the urethra and the pelvic floor muscles are unable to prevent the urine from escaping, either due to one or a combination of structural, muscular, or nervous system injuries.
Urge incontinence is loss of urine subsequent to a sudden urge to urinate. This condition is usually as a result of bladder muscle contractions overcoming the resistance from the urethra and loss of urine. Neurological and medical issues are normally the most common reason for this type of disorder.
Overflow incontinence is a bladder condition were the bladder does not being able to empty and loss of urine occurs as a result of overflow. This usually is a problem of bladder muscle weakness, nervous system damage, or obstruction of the urinary outflow due to surgery, tumor, or stone.
Overactive bladder presents with symptoms of urinary urgency and frequency, sensation of incomplete bladder emptying, and multiple night time voids. These symptoms usually represent bladder muscle irritability and could be as a result of nervous system problems, kidney stones, bladder cancer, and many of other possible etiologies.
Evaluation of Urinary Incontinence
Evaluation process for urinary incontinence can be quick and simple or complex requiring multiple diagnostic modalities. Evaluation begins by a detailed history and physical covering the present symptoms and duration, medical and surgical history, and obstetric history as well as a detailed Gynecological and urological examination.
A urinalysis is helpful to rule out infection, kidney stones, or risk of kidney disease or cancer.
Ultrasound of the kidney and bladder as well as gynecological organs allows identification of tumors and growths that may be responsible for the incontinence.
A cystoscope is an specially designed instrument for evaluation of the bladder. We use small cystoscopes designed for evaluation of a woman’s body. These instruments are delicate minimizing the discomfort and allow maximal diagnostic ability.
Urodynamic testing is a functional study of the bladder and the urethra identifying weakness in the system interaction during voiding or storage of urine.
CT urogram and MRI allows identification of the kidney and bladder lesions and spinal defects.
Treatment Options for Urinary Incontinence
Treatment options include physical therapy, medication, natural remedies, fluid and diet alterations, weight management, urethral bulking injections, and vaginal surgical repairs.
These treatment options can be very successful when targeted at the correct cause of incontinence.