Incontinence is defined as the involuntary leakage of urine from the bladder. It can affect both men and women of any age group but is more common in women and the elderly. Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life.
Many people think urinary incontinence is part of the aging process, but it is not. It can be managed and treated.
There are different types of incontinence, the most common being urge incontinence and stress incontinence.
Urge incontinence is characterized by spontaneous and uncontrolled urine leakage often accompanied by the overwhelming sensation of needing to void. The cause of urge incontinence are not clearly known but can be do to urinary tract infection, diabetes and neurologic disorder.
Stress incontinence is the involuntary loss of urine during or after lifting, sneezing, physical exertion, coughing or laughing. It is primarily due to weakness of the urethral sphincter and loss of pelvic support. Risk factors for stress urinary incontinence include vaginal delivery, smoking, obesity, and age.
These two types of incontinence can be present separately or in combination. For this reason, proper evaluation is needed to direct appropriate therapy.
Evaluation The basic evaluation of a patient with incontinence includes a thorough history and physical, pelvic examination, bladder diary, post void residual assessment and urine analysis.
Further evaluation by a urologist may include cystoscopy or urodynamic testing.
A small implanted device that is FDA approved for overactive bladder and urgency incontinence. This small device sends impulses that target the sacral nerves that effect bladder sensory stimulation. Several multicenter clinical studies have reported significant and long-term improvements in patients with overactive bladder and urgency incontinence.
Botox ® for the treatment of urgency incontinence was FDA in 2013. Botox works by calming the nerves that trigger overactive bladder and urgency incontinence. This short outpatient procedure is performed under general anesthesia and takes approximately 30 minutes. One Botox ® injection can last up to 6 months. To learn more about Botox ® for urgency incontinence and overactive bladder click here.
There are a variety of urethral bulking agents. The most common one used today is Durasphere®. This agent is composed of small carbon beads. It is injected into the urethra and provides coaptation and improved sphincter function. This short minimally invasive procedure is performed in the outpatient setting under general anesthesia. Patients are able to return the work the next day.
The pubovaginal sling is one the most popular procedures performed for stress urinary incontinence in women. The pubovaginal slings have excellent overall success and durable cure rates. There are a variety of materials that compose the pubovaginal sling and include synthetic mesh, autologous fascia, allograft materials and Xenografts. To learn more about stress urinary incontinence and pubovaginal slings click here.
The inflatable artificial sphincter is a medical device that keeps urine from leaking when the urinary sphincter no longer works well. When you need to urinate, the cuff of the artificial sphincter can be relaxed so urine can flow out. The sphincter is the most effective, reliable, and durable surgical treatment for men with postprostatectomy urinary incontinence, achieving social continence rates of 75-95%. To learn more about this device and male incontinence click here.