Urinary incontinence

Have you noticed, over the past year or so, an increase in the number of advertisements for products to manage urinary incontinence caused by overactive bladder? Well, if you have, it’s not your imagination, regardless of how late you stay up at night. The facts are that urinary incontinence is one of the 10 most common chronic conditions in the United States, affecting over 10 million people of all ages, and that number is rising. It can affect your sex life, social life, career, and hobbies and recreational pursuits, not to mention your psychological well-being. But it can be successfully managed, if not eliminated - hence all the ads. And there are many more options than simply wearing a pad or taking a pill.

The most important factor in determining treatment for incontinence is determining the cause. While an overactive bladder is perhaps the most obvious culprit, a weak bladder, urinary tract infections, vaginal infection or irritation, and constipation can also play a role. Neurological damage or illness is also a cause of incontinence. In men, a blocked urethra, often resulting from prostate enlargement or surgery, can result in urinary incontinence.

Perhaps the most frequent type of incontinence is what’s known as “stress incontinence.” It’s common in women who have had their muscles stretched as a result of childbirth. With this type of incontinence, any activity that temporarily increases the pressure within the abdomen and consequently the bladder, such as coughing, sneezing or laughing, may cause urine to escape - even if the bladder isn’t full.

Pelvic muscle exercises (PMEs), also known as Kegel exercises, are a popular treatment for stress incontinence. Essentially, they involve tightening the pelvic floor muscles as if you’re trying to control urination or defecation.

Another option to tone and tighten the pelvic muscles involves electrostimulation via a small rectal or vaginal probe. These devices passively exercise the pelvic floor muscles using electrical pulses - and yes, it’s painless.

Recently, in the United States, two new prescription devices for stress incontinence in women became available. They are the Reliance Urinary Control Insert, also known as a urethral plug, and the Miniguard Patch.

The Reliance Insert is a single-use, balloon-tipped cylinder about one-fifth the size of a tampon. It’s placed in the urethra with an applicator. However, a fairly high infection rate was seen in women who used the device during the clinical trials. The infection rates decreased as the women got used to using the device.

By comparison, the Miniguard Patch is used externally to provide a barrier to leakage. It is used once, then replaced with a new patch. It provides an alternative to pads.

Then there’s urge incontinence, which is the “involuntary loss of urine associated with a strong desire to urinate.” In other words, you may not be able to get to a toilet in time, due to strong and involuntary contractions of the bladder muscles.

Medications used to treat urge incontinence generally work by relaxing the bladder muscles to stop the abnormal contractions. They include anticholinergics, such as propantheline, and antispasmodics such as oxybutynin.

As far as surgery goes, it is typically used to correct anatomical problems that are causing incontinence. It can also be used to remove blockages. But surgery can also be performed to add rather than remove a blockage. The procedure involves injecting collagen around the urethra, effectively narrowing the urethra, which in turn increases resistance to the flow of urine.

Now, I realize I have only touched the tip of the iceberg here, but if you think you may have overactive bladder, keep a diary or a record of some kind for a week or so, to see how often you go to the toilet. And talk to your doctor. After all, there is no reason to suffer in silence - much can be done.

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SOURCE: British Journal of Urology International

Provided by ArmMed Media
Revision date: June 22, 2011
Last revised: by Dave R. Roger, M.D.