Incontinence

Urinary incontinence is the unintentional release of urine. There are three types of incontinence:

• Stress incontinence: urine loss during physical activity that increases abdominal pressure e.g. coughing, laughing, sneezing
• Overflow incontinence: constant dribbling of urine, bladder never completely empties.
• Urge incontinence: urine loss with urgent need to void and involuntary bladder contractions.

Incontinence occurs in both men and women for different reasons. For women, the majority of cases are stress urinary incontinence which is the weakening of the pelvic floors that supports the organs of the lower urinary tract. This is normally due to childbirth, pelvic surgery and/or menopause or estrogen deficiency. For men, incontinence is usually caused by a damaged sphincter often due to the removal of the prostate which cannot squeeze and close off the urethra, causing urine to leak.

Once symptoms occur the following diagnostic tests may be performed to evaluate whether or not cancer is present in the bladder:

• Urine culture: a urine sample is tested for signs of bacterial infection.
• Urine flow: a measurement of the rate of urine flow to determine how well the bladder is functioning.
• Cystoscopy: a telescope like instrument is inserted through the urethra to closely examine the inside of the urethra and bladder.
• Cystometrogram: a catheter is inserted into the urethra and bladder in order to measure and record bladder pressure.
• Cystogram: a catheter is inserted and the bladder is slowly filled with a special dye to make the bladder visable; then an x-ray of the bladder is taken.

TREATMENT

The treatment of incontinence depends on the type of incontinence.

STRESS INCONTINENCE

• Injectables: uses an injecting material e.g. collagen, fat, Durasphere® to increase the bulk around the urethra to improve the function of the urethral sphincter and compress the urethra near the bladder outlet.
• Kegel Exercise: uses a tightening and relaxing of the sphincter muscle to promote strengthening of the pelvic floor.
• Medications: use alpha-adrenergic agonists which stimulate receptors that respond to norepinephrine, a hormone and neurotransmitter.
• Hormone replacement therapy (HRT): uses estrogen and progestin medication to restore the health of the urethral tissue in postmenopausal women.
• Percutaneous Sling/Transvaginal Sling: use a strip of tissue or synthetic material to create sufficient urethral compression to achieve bladder control.

URGE INCONTINENCE

• Medications: use anticholinergic and alpha-1-andrenergic blocking agents to relaxe smooth muscle tissue and have an antispasmodic effect on overactive bladder. Common Medications: Pro-Banthine®, Ditropan®XL, Oxytrol®, Flomax®, Cardura®
• Bladder retraining: a voiding diary is kept of all episodes of urination and leaking and is then analyzed for a pattern of urination. This timetable is used to plan when to empty the bladder to avoid accidental leakage.
• Bladder Augmentation: a surgery performed to increase the capacity of the bladder by adding bowel segments or reducing the muscle-squeezing ability of the bladder.
• Sacral Nerve Stimulation: Axonics® therapy is a reversible treatment for urge incontinence caused by overactive bladder. Axonics® is an implanted neurostimulation system that sends mild electrical pulses to the sacral nerve, the nerve near the tailbone that influences bladder control muscles.
  

OVERFLOW INCONTINENCE

• Medications: use alpha-1-andrenergic blocking agents to relax striated and smooth muscle, decreasing urethral resistance and relieving symptoms.
• Common Medications: Hytin®, Flomax®, Cardura®
• Intermittent Self-Catheterization: uses a catheter to drain the bladder every 3 to 8 hours to keep urine volumes low.