Urinary Incontinence

Urinary incontinence is the inability to hold urine even till reaching the toilet. 1 in 10 women experience urinary incontinence. Women experience incontinence twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But, both women and men can become incontinent from neurologic injury, birth defects, strokes, multiple sclerosis, and physical problems associated with aging.

Stress Incontinence

If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have Stress Incontinence. Physical changes resulting from pregnancy, childbirth and menopause often cause stress incontinence. It is the most common form of incontinence in women and is treatable.

Urge

Leakage of large amounts of urine at unexpected times, including sleep.

Mixed

Combination of both stress and urge incontinence

Overflow

when bladder becomes full with urine small amount leaks continously as it now becomes overfilled.

How is incontinence evaluated?

To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence. Other obvious factors that can help define the problem include straining and discomfort, use of drugs, recent surgery, and illness. If your medical history does not define the problem, it will at least suggest which tests are needed.

Your doctor will physically examine you for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be an evidence of a nerve-related cause.

Your doctor will measure your bladder capacity and residual urine for evidence of poor functioning of the bladder muscles. To do this, you will have to drink plenty of fluids and urinate into a measuring pan, after which the doctor will measure the urine still remaining in the bladder.

Your doctor may also recommend:

• Stress incontinence test - You relax, then cough vigorously as the doctor watches for loss of urine


• Urinalysis - Urine is tested for evidence of infection, urinary stones, or other contributing causes.


• Blood tests - Blood examined for substances related to causes of incontinence.


• Ultrasound - Sound waves are used to "see" the kidneys, ureters, bladder, and urethra.


• Cystoscopy - A thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.


• Urodynamics - Various techniques measure pressure in the bladder and abdomen and the flow of urine.


• Voiding Diary - Your doctor may ask you to keep a diary for a day or more, up to a week, to record when you void. This diary should note the times you urinate and the amounts of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim.



The principle areas of surgical activity in reconstructive urology at AG Stone are:

Treatment

Exercises

Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage. Women of all ages can learn and practice these exercises, which are taught by a health care professional.

Electrical Stimulation

Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.



Biofeedback

Biofeedback uses measuring devices to help you become aware of your body's functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can be used along with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Timed Voiding or Bladder Training

Timed voiding (urinating) and bladder training are the techniques that use biofeedback. In timed voiding, you fill a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Biofeedback and muscle conditioning(known as bladder training)can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.

Medications

Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally.

Surgery

Doctors usually suggest surgery to reduce incontinence only after other treatments have been tried. Most stress incontinence results due to dropping down of the bladder towards the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament or bone. Transvaginal or Trans-obturator tape(TVT/TOT).