Female Incontinence Review

How Common Is Incontinence?

Incontinence affects approximately 10 million Americans, without regard to sex and age. That means one out of every 25 Americans suffer from some type of incontinence.


Why Seek Help?

Besides the social stigma of embarrassing odor and wetness, skin may be damaged by urine. With the technology of the 90s, most incontinence can be treated or at least managed to allow full participation in a satisfactory life-style.


Definitions

Incontinence can be simply defined as the unwanted loss of urine. There are actually many types of incontinence, and for successful treatment the type of incontinence must be defined properly.

The three major types of incontinence are urge incontinence, stress incontinence, and overflow incontinence.

Urgency Incontinence
Urgency incontinence is the unwanted loss of urine that is usually associated with an abrupt and very strong urge to urinate. Urgency incontinence is often seen in people with nerve damage, particularly of the spinal cord in diseases like multiple sclerosis. The other main cause for urgency incontinence is the presence of some irritating force within the urinary tract that causes the patient to lose his urine involuntarily. This could be any type of infection of the bladder, prostate, or urethra. This would include such diagnoses as prostatitis and various forms of cystitis or bladder inflammation. This could also be seen in bladder wall-damaged patients such as those who had received radiation therapy. The treatment of urgency incontinence is directed at the causative factors. If the urgency incontinence is caused by nerve damage for any reason, drugs are used to suppress the urge to urinate. If the cause of the urgency incontinence is any one of the irritating forces, then trying to relieve the bladder with medication or, of course, trying to treat the cause of the irritation if it is treatable. In some circumstances such as radiation-damaged bladder the radiation cannot be undone, but the bladder can often be relaxed by using medications that decrease the amount of bladder sensitivity.

Stress Incontinence
Stress incontinence is the unwanted loss of urine that occurs during periods of activity such as coughing, sneezing, laughing, or running. This is often seen in women who have had multiple children, and this type of incontinence can be treated surgically, or with some forms of biofeedback teaching. In men, stress incontinence is rare because the prostate provides a major blockage of urine in most men, which gives them added control. In men who have had radical prostate surgery, the prostate is removed and the sphincter is often left somewhat shortened in the attempt to remove all of the cancer. These men may have stress incontinence and may need to wear pads or diapers on a continuing basis. Some drugs such as Ephedrine and Sudafed can often be used to help increase the tone of the remaining sphincter. Doing exercises to strengthen the muscles of the sphincter area are often helpful. These exercises called Kegel’s exercises need to be done on a frequent and continuing basis to keep the muscle tone at its maximum. Women often use this exercise as well after pregnancy. In men after radical prostate surgery with continuing incontinence, surgeons can place an artificial sphincter around the urinary channel downstream from the normal sphincter in an attempt to aid in controlling the urine. The surgery has a fairly high success rate, but should not be considered until the patient has been incontinent for at least a year to ensure that spontaneous return of function will not occur. Sometime in the next twelve months we are hopeful to have available collagen injections that can be placed outside the sphincter to help strengthen its presence, and this might be an easier solution in some patients for the treatment of stress incontinence.

Overflow Incontinence
Overflow incontinence is the unwanted loss of urine that is associated with an overdistended or unemptying bladder. Most people present with a frequent or constant dribbling of urine, and may have some components of urgency incontinence and stress incontinence as well. Overflow incontinence is usually due to either a blockage of the outflow of the urinary tract such as an enlarged prostate from either benign prostate enlargement or prostate cancer. The overflow incontinence can also be due to an underactive or poorly contracting bladder, which does not sense the filling of urine. Nerve damage, particularly those which give the patient little sensitivity of filling of urine such as multiple sclerosis and in some diabetics, the treatment is difficult and may require continuous catheterization or patient selfcatheterization programs. If the overflow incontinence is caused by a blockage such as a large prostate or prostate cancer, these diseases can be treated by surgery or medications, and in many over a period of time with a catheter or with intermittent catheterization bladder tone will return.


Evaluation

Many times the various types of incontinence are present together making the diagnosis somewhat more difficult. The basic evaluation of the patient with incontinence should include a complete history and physical examination with a urinalysis. A good history should include the exact characteristics of the periods of incontinence and the voiding patterns of the patient. A list of precipitating factors and list of all the important urinary tract symptoms should be included. Because the bladder has the same nerve roots as the bowel and sexual functioning, these should also be included in the history. An exact number of the use of pads, both amount and type, should be included, and any previous treatments for incontinence should be included as well. See the list below about the things that we need to know.

We may ask you to keep a chart of your voiding pattern to help us make a firm diagnosis or to help us with treatment to see how successful we are in treating your condition:

  • When do you go to the bathroom and how much? (Use an old jar to measure.)
  • When do you experience wetness? During or after lifting? While coughing, sneezing, or straining? Day, night, or both? Before or after going to the bathroom?
  • How much urine do you lose? Estimate amounts in teaspoons, tablespoons, or parts of a cup.
  • Do you have trouble stopping or starting the flow of urine?
  • What is your daily fluid intake? (Amount and description of what you drink.)
  • Be prepared to name the medications you take and any surgery you have had on your urinary tract or around it. When you have this information ready, it is easier for the doctor to proceed with an evaluation.
  • If you have had previous treatment for incontinence, bring those records or X-rays with you.

Physical examination should include a complete abdominal and genital exam. A pelvic examination and a rectal exam is necessary both to look for masses and test the nerve function of the muscles of the perirectal area. Additional testing that is often helpful is a measurement of the amount of urine left in the bladder after voiding, and in some patients a rate of urinary flow. A urinalysis must be done looking for any signs of infection. In some patients a detailed voiding record that measures time and amounts of urine over a one to two day period can be quite helpful. In some patients more specialized tests are indicated, including x-ray evaluation of the kidneys, ureters, bladder, and urethra. A telescopic examination of the urethra, the sphincter area, bladder, and in men the prostate is often necessary to make access the physical and anatomic characteristics of these organs. In many patients various forms of cystometry is necessary. There are various forms of cystometry, including the cystometrogram which is a measure of pressure within the bladder. This can often be aided by EMG studies or electromyography, which measures the muscles around the anus and bladder neck, and also video studies of voiding for identification of complex problems, particularly lack of coordination of the various muscles necessary to achieve adequate urination.


InterStim® Therapy for Urinary Control

InterStim Therapy is a proven neuromodulation therapy that targets the communication problem between the brain and the nerves that control the bladder. If those nerves are not communicating correctly, the bladder will not function properly.

Visit www.everyday-freedom.com to learn more about InterStim Therapy and get support during your personal journey. On this website you will have the opportunity to:

  • Watch videos to hear what doctors and patients have to say about InterStim Therapy.
  • Register to receive email updates adn the Everyday Freedom newsletter via email.
  • Track your bladder symptoms.
  • Get answers to common questions, including the benefits and risks associated with InterStim Therapy.
  • Get matched up with a volunteer patient ambassador to discuss their real-life experiences with InterStim Therapy.

Download an Introduction Brochure by clicking here.


What Will Be Done?

As discussed above incontinence has many different causes. The diagnosis will point to the treatment or management that is best for you. Some of the possible treatments are muscle strengthening, electronic stimulation, medicine, surgery, injections of collagen into the sphincter to increase tone, periodic catheterization, external collectors, and absorbent products. Each treatment is personalized to your needs and diagnosis. Often, multiple treatment options for each situation will exist and it will be up to the patient, with their Urologist’s help, to select the best first option to try.


For more information about the various types of urinary incontinence in adults, and support groups, one can order a clinical guideline from the U.S. Department of Health and Human Services, 2101 East Jefferson Street, Suite 501, Rockville, Maryland 20852, and ask for publication AHCPR 92-0038.

The Leading Urological Group of Central Illinois Since 1945