| Urinary Incontinence
Incontinence of urine can have a very profound affect on your daily life. It can cause you to become homebound and constrained. It can cause depression and be very embarrassing. Patients often do their best by adapting to their situation by restricting fluid intake, planning their day according to the availability of a nearby bathroom, and having to carrying pads or diapers with them. Patients dealing with incontinence will also be dealing with a very high cost of diapers and appliances.
Urinary incontinence can be classified into two separate categories according to its cause. The first is known as the overactive bladder or OAB and the second is known as stress urinary incontinence.
Types of incontinence
- Urge Incontinence - Leakage associated with an overwhelming need to urinate also known as overactive bladder or OAB (Gotta go, gotta go!)
- Stress Incontinence - Leakage during physical activity that increases intra-abdominal pressure, i.e. lifting, exercising, sneezing, and coughing
- Mixed Incontinence - Combination of the above
OAB is defined by having several urinary symptoms including urgency with or without incontinence, frequency of urination during the day and at night (nocturia). This is condition is often referred by urologists as lower urinary tract symptoms abbreviated to LUTS.
Overactive Bladder is a common medical condition that affects up to 542 million Americans and Europeans. In the US 16.6% of the adult population suffers from OAB. Of those 6.1%or 12.2 million will have severe OAB, which we define as “Wet” involving accidental leakage of urine. OAB is not a natural part of aging and should be treated-- you can do something about it. It is not a result of drinking too much fluid and neither does it exist because you have a weak bladder. The risk of having an OAB increases with age. At 60 or older approximately 5% of men are incontinent due to OAB. Certain medical conditions such as diabetes are linked to OAB and frequent urination at night (nocturia).
In a study published in the March 2008 issue of the journal Diabetes Care diabetes is positively associated with irritative lower urinary tract symptoms (LUTS) and nocturia but not benign prostatic hyperplasia (BPH)." The researchers found that diabetes was associated with irritative LUTS and nocturia "consistently across racial groups." Furthermore, "The relationship between irritative LUTS and diabetes was greater in black men.”
If you often experience a strong uncontrollable urge to urinate with barely any time to make it to the bathroom, or if your sleep is disturbed 2 or more times a night with the need to rush to the bathroom, you may be suffering from OAB and you should contact a health care professional for treatment.
How the Bladder works
- Bladder collects urine
- The sphincter - a circular muscle at the level of the prostate - controls the flow of urine
- The sphincter muscle wraps around the urethra
- A healthy sphincter stays closed until one relaxes it to urinate
In men, the urinary sphincter muscle is located below the prostate. This muscle surrounds the Urethra. When the sphincter muscle tightens, it holds urine in the bladder. When it relaxes, the bladder muscle also known as the detrusor contracts and the urethra opens, allowing urine to flow outside the body. Usually these contractions are under your own control but when the muscle in your bladder receives sudden messages to contract before you are ready to urinate, it’s called overactive bladder. As a man ages, the prostate size increases, narrowing the bladder opening. This chronic condition causes the bladder muscle to thicken inwardly, thus decreasing the inner volume of the bladder. In addition the detrusor becomes stiffer with decreased flexibility and compliance and increased resistance to stretching. Thus a man with an enlarged prostate
will often urinate with a slower narrower, weaker stream, smaller volumes of urine and with more frequency. Stretching of the thickened detrusor muscle will provoke a sudden urge to urinate. This is also known as urgency.
The overactive bladder has various symptoms.
1) Involuntary loss of urine.
2) Continuous leakage when the bladder is full.
3) Making 8 or more trips to the bathroom in a 24hour period.
4) Inability to stop leakage long enough to reach a toilet (urgency incontinence).
5) Leaking or wetting accidents (urinary incontinence).
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- Enlargement of the prostate also known as benign prostate hypertrophy (BPH).
- Aging of the bladder.
- Combination of factors or in some patients often unknown.
- Urinary Tract infections such as cystitis, prostate infections and certain medications may cause temporary OAB.
- Diseases like Parkinson’s disease, stroke and diabetes could cause OAB.
- DESD: Detrusor external sphincter dyssynergia may result in incontinence. It is mostly seen with patients with spinal cord injury and multiple sclerosis.
The diagnosis of OAB depends largely on patient self-described symptoms of frequency, nocturia, and urgency. Many patients avoid discussing the issue with their physicians and delay in seeking care. When taking a history, age, onset, description, nocturia, prior therapy, history of neurological disorders and patients’ expectations are the main topics to discuss with the doctor. In addition a simple physical exam of the abdomen and pelvic area is necessary to complete the initial evaluation. A voiding diary is very important and provides useful information. The volume of each void is key. The diary also allows for baseline and comparative assessment of a treatment. The night and first morning voids are most likely to demonstrate the bladder’s ability to store urine. Special questionnaires are also very useful to measure the severity and bother from OAB and these can also be used to evaluate efficacy and progress from a given treatment option.
What to expect at an office visit
- Spinal or neurologic disease
- History of BPH
- Postvoid Residual
- Urodynamics, Cystoscopy
What else can be needed for the diagnosis?
Imaging (x-rays) is rarely necessary. It is indicated if a kidney evaluation is needed, however a kidney ultrasound study may be just as good as an x-ray, without the getting radiation. The doctor may request a MRI of the spine if a neurological problem is suspected. A urodynamic test is indicated when the cause of the incontinenece is not entirely clear, to confirm or rule out a a diagnosis.
What is Urodynamics?
This is a study of the Urinary Bladder. It involves a series of tests that measure the function and pressure in the bladder as well as the flow of urine through the urethra (passage through which urine is passed out of the body). It provides extremely important information on how much urine the bladder can hold, if there is a blockage, if the bladder is overactive, and bladder strength.
Who may need the Test?
Doctors may recommend Urodynamic testing for patients with Urinary Incontinence (leakage or loss of control of urine) or difficulty passing urine—frequency, urgency, incomplete bladder emptying, night time urinating..etc…
It also can also differentiate between the need for medical or surgical treatment.
The procedure and what to expect
Upon arrival you will be asked to empty your bladder into a commode that will measure how fast your urinating.
Next, while lying on a table, a small, flexible, lubricated catheter will be placed into the bladder through the urethra. Anesthetic jelly is used. Another small catheter will be placed in the rectum(anus). These 2 catheters will be connected to the computer.
Three small sticky pads will be placed to measure the activity of the valve below the bladder—to see if it is opening and closing appropriately.
Lastly, you will again be asked to sit on a commode and your bladder will be filled with sterile water while the computer monitors function. You may be asked to cough or strain down to see if urine escapes or leaks. This is part of the test. Once you are full or feel like you have to urinate, you will be asked to empty your bladder and then the test is complete.
The test takes 30-45 minutes. At the end of the test, the catheters will be removed and you will be given antibiotics for a few days.
Preparing for the Test
1. No need to fast and you can take your usually medications.
2. Please come with a full bladder and do not urinate upon arrival.
3. Try to empty your bowels before the test.
4. If you have a catheter, you do not have to come with a full bladder.
5. *** Please notify us if you take antibiotics before going to a dentist or if you have had Hip, Knee Replacements or Heart valve Replacements***
YOU WILL NEED ANTIBIOTICS PRIOR TO THE TEST!
After the test
You will be advised to drink plenty of water for 24 hrs to flush out the bladder. Infection is very rare. If you should experience any symptoms like fever or persistent pain when passing urine, please seek medical attention. You make experience a little discomfort or slight bleeding that should settle within 48 hrs.