Incontinence

Introduction
Urinary incontinence is a common problem that occurs in both males and females. Incontinence occurs when there is an involuntary loss of urine or feces; the primary focus of this facility is urinary incontinence. Treatment for urinary incontinence depends on the specific cause of the incontinence, which much be determined by your doctor.

Symptoms
There are five different types of urinary incontinence, each with a different set of symptoms.

Stress incontinence –
variable amount of urine escaping suddenly
urinary loss is predictable
leaks with increase in abdominal pressure (cough,laugh,sneeze)

Urge incontinence (also known as overactive bladder) –
Uncontrolled urine loss; strong urge to go to the bathroom
Sudden and rapid urge to urinate without any warning
Associated with frequent urination, urgent need to urinate, awakening at night to urinate

Mixed incontinence –
Symptoms of both stress incontinence and urge incontinence

Overflow incontinence –
Urine overflows from the bladder
Small amounts of urine leak continuously

Functional incontinence –
Relatively normal bladder control
Other conditions affect ability to reach the toilet on time

Diagnosis
Your doctor will perform a detailed history and physical exam.

Other tests include:
Voiding Diary – your doctor may ask you to keep a record of your bladder activity
Pad Test – test that determines whether the fluid lost is indeed urine
Urine Studies (i.e. urinalysis, cytology, etc.)
Post-void residual volume – test for the amount of fluid left in the bladder after urination
Cough stress test
Q-tip test

Treatment
Treatment of incontinence depends on the type and severity of the problem. Simple lifestyle changes may help to improve some types of incontinence. These include limiting fluids at certain times or retraining the bladder by developing a schedule for trips to the bathroom. Kegel exercises are often recommended, to strengthen the pelvic muscles that help hold urine in the bladder.

Medication is sometimes prescribed to block the nerve signals that cause urgency and frequent urination, or to relax bladder muscles and prevent spasms. Your doctor will probably also review the medicines you already take, to find any that may contribute to bladder control problems and suggest changes that could solve the problem.

For patients who did not benefit from medication or lifestyle changes there is InterStim therapy, Botox injections, or percutaneous nerve stimulation. InterStim therapy modulates the sacral nerves with mild electrical pulses. This helps the brain and the nerves communicate so the bladder and related muscles can function properly. Percutaneous Nerve Stimulation also sends signals to the nerves of the bladder to decrease urinary incontinence. Finally, Botox injections help the bladder muscle to not contract as frequently.

Surgery can offer long-term relief for some types of incontinence. Many women have benefited from placement of synthetic material underneath the urethera to prevent incontinence.

Prognosis
The prognosis for urinary incontinence is excellent with currently available treatments. Patients with incontinence should not expect or experience morbidity and mortality. The well being of a patient with urinary incontinence varies depending on the escalation of the condition, but urinary incontinence is easily preventable and treatable.

Resources
National Association for Continence
American Urogynecologic Society
American Medical Systems
AUA position on Vaginal Mesh for SUI