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Canandaigua Medical Group Urinary Incontinence Kerman Bharucha student working under Wendy Ames, PA November, 2002 Urinary Incontinence (UI) is defined as an inability to prevent the escape of urine from the bladder. Bladder control problems affect more than 25 million Americans each year. There are several types of urinary incontinence: Stress Incontinence: This is by far the most common UI, accounting for 60% of all UI cases. Stress incontinence occurs when the muscles of the pelvic floor weaken, thus allowing the bladder neck to sag. Damaged urinary sphincter-muscles, which can no longer hold back urine as effectively as they could prior to the damage, can also cause stress incontinence. This damage may be related to stretching or laceration of the vaginal wall (as in childbirth), or to atrophy of the vagina because of a lack of estrogen (as in menopause). Urine letdown occurs when the abdominal muscles create pressure on the bladder that exceeds the capacity of the urethral sphincter muscle to hold the urine back. A slight loss of urine is likely to accompany everyday activities and events, such as laughing, coughing, sneezing, exercising, or lifting. Nocturnal Enuresis: "Nocturnal enuresis" is the medical term for night-time bed-wetting, a bladder control problem that affects thousands of children yearly. For some children, bed-wetting can remain a problem for several years, even into the teenage years. Urge Incontinence: As ...
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Canandaigua Medical Group Urinary Incontinence Kerman Bharucha student working under Wendy Ames, PA November, 2002 Urinary Incontinence (UI) is defined as an inability to prevent the escape of urine from the bladder. Bladder control problems affect more than 25 million Americans each year.There are several types of urinary incontinence: Stress Incontinence: This is by far the most common UI, accounting for 60% of all UI cases. Stress incontinence occurs when the muscles of the pelvic floor weaken, thus allowing the bladder neck to sag. Damaged urinary sphinctermuscles, which canno longer hold back urine as effectively as they could prior to the damage, can also cause stress incontinence.This damage may be related to stretching or laceration of the vaginal wall (as in childbirth), or to atrophy of the vagina because of a lack of estrogen (as in menopause).Urine letdown occurs when the abdominal muscles create pressure on the bladder that exceeds the capacity of the urethral sphincter muscle to hold the urine back. A slight loss of urine is likely to accompany everyday activities and events, such as laughing, coughing, sneezing, exercising, or lifting. Nocturnal Enuresis: "Nocturnal enuresis" is the medical term for nighttime bedwetting, a bladder control problem that affects thousands of children yearly. For some children, bedwetting can remain a problem for several years, even into the teenage years. Urge Incontinence: As the name implies, this condition is characterized by a sudden, strong desire to urinate. Normally, the detrusor muscle controlling the bladder contracts and relaxes according to the volume of urine in the bladder, and the initiation of urination. In people with an overactive bladder, the detrusor muscle contracts spastically, sometimes without a known cause, which results in sustained, high bladder pressure. An overactive bladder can progress to urge incontinence.It interferes with work, daily routine, and intimacy.People with the condition typically experience the urgent need to urinate at inconvenient times and may lose control before reaching a toilet. It causes embarrassment, and may diminish selfesteem and quality of life. Urge incontinence can be caused by infections, sphincter disorders or nervous system disorders that affect the bladder. Blockages caused by bladder stones can also be responsible for urge incontinence. Overflow Incontinence:This condition is fairly prevalent in men, but is rarely seen in women. The bladder fills up, but this sense of fullness is not conveyed to the detrusor muscle of the bladder which would provide the actual contractions to expel urine. The bladder, therefore, does not contract to expel the urine, but allows for passive overflow and leakage of small amounts of urine almost on a continuous basis. The stagnation of residual urine in the bladder could lead to bladder infections. Environmental Incontinence: Environmental incontinence does not indicate a physical problem with the bladder or the urinary tract. However, external restrictions such as physical disabilities or mobility issues may prevent the patient from reaching the toilet on time, or removing their clothing on time. QUALITY CARE FOR ALL AGES1 ©Copyright Canandaigua Medical Group, 2004 335 Parrish Street ∙ Canandaigua, NY 14424 (585) 3932888 www.canandaiguamedical.com
Canandaigua Medical Group Mixed Incontinence: Mixed incontinence simply means that the patient suffers from a combination of bladder control disorders. The most common combination of disorders is stress incontinence and urge incontinence. Transient Incontinence:Transient incontinence refers to temporary episodes of incontinence. Causes of transient incontinence might include medication side effects, infections of the bladder or urinary tract, or even severe constipation. Conclusion:Urinary incontinence is a significant social, psychological and health problem for women of all ages. UI is not a normal consequence of aging, and it can be successfully treated 80% of the time. The treatment options are varied, and can be broadly classified as nonsurgical and surgical. NonSurgical Treatments: •Pelvic muscle exercises:These are designed to strengthen the pelvic floor muscles, and can be an effective treatment option for women with stress incontinence. •Biofeedback:Electrical signals that are given off when specific muscles are squeezed can be analyzed by machines. The feedback given back to the patient allows the patient to adjust the mechanics of the exercise for optimum advantage towards bladder control. •Bladder training:The patient is taught how to postpone urination and to urinate according to a specific timetable. •Medications:Sometimes medications can inhibit bladder muscle contractions and increase urethral sphincter tone. •Diet:Acidic, spicy or caffeineloaded foods can contribute to urinary problems. Diet modifications need to be geared to an individual's specific problem. Surgical Treatments: At times, minimally invasive surgical techniques that require small incisions and have a corresponding short recovery time may become necessary to restore bladder control. •Support sling:A sling made from a patient's own tissue or from mesh tape is used to restore support to the bladder neck. •Pessaries:A pessary is a ring inserted into the vagina. The pressure helps support the bladder neck, leading to less stress leakage. •Bladder suspension:Sutures are placed laparoscopically in the vaginal wall to support and stabilize the bladder neck.. QUALITY CARE FOR ALL AGES2 ©Copyright Canandaigua Medical Group, 2004 335 Parrish Street ∙ Canandaigua, NY 14424 (585) 3932888 www.canandaiguamedical.com
Canandaigua Medical Group •Artificial sphincter:In some complicated cases, an inflatable device is implanted to encircle the urethra and block urine from leaking out. When the patient wants to void, s/he presses a button to deflate the cuff, thus allowing the urine to flow out. •Implantable electronic stimulator:A pacemakerlike device delivers a mild electric current (undetectable to the patient) to the nerves controlling the bladder and pelvic floor muscles to reduce or eliminate urge incontinence. •Other implants:Implants are collagen derivatives that are injected into tissues around the urethra. The bulky implants help to close the urethra, thus reducing stress incontinence. _____________________________ Your doctor knows you and your family best. Nothing takes the place of talking directly with your doctor about your health and questions that you have. The information provided here is not medical care or treatment and is not specific to your situation. You need to contact your own doctor for your medical care. QUALITY CARE FOR ALL AGES3 ©Copyright Canandaigua Medical Group, 2004 335 Parrish Street ∙ Canandaigua, NY 14424 (585) 3932888 www.canandaiguamedical.com
