Incontinence

• Incontinence affects all ages, both sexes, and people of every social and economic level.
• An estimated 12 million Americans have some problem controlling urination.
• It is treatable and generally does not require surgery.

Answer the following questions:

1. Do you leak urine with coughing, sneezing, lifting?
2. Do you leak urine before you make it to the bathroom?
3. Do you need to wear protective undergarments for urine leakage?

If you answered yes to one or more, you know what incontinence is!

• Urinary tract or vaginal infections
• Effects of medicine
• Constipation
• Weakness of certain muscles
• Blocked urethra due to an enlarged prostate
• Diseases and disorders involving nerves and/or muscles
• Some types of surgery

• Stress incontinence: Leak urine with exercise, cough, sneeze.
• Urge Incontinence: loss of urine as soon as they sense need to use toilet. "Can't get there quickly enough"
• Mixed incontinence: combination of the above
• Overflow incontinence: feeling of incomplete emptying, lose small amounts day and night

• Is the problem bothersome?
• Does it alter your quality of life?
  • If so: Tell your doctor, he or she can help!

• Urinalysis to examine for presence of infection, blood, or other abnormalities
• Post-void residual measurement to see if any urine remains after an attempt has been made to completely empty the bladder
• Ultrasound to determine the size and shape of the kidneys, bladder, and prostate
• Cystoscopy using a thin telescope, allows the physician to see inside the bladder
• Stress test examines bladder and sphincter muscle function
• Urodynamics specialist test to see how bladder is working

• Behavioral Therapy. Special exercises and training to strengthen the sphincter muscles.
• Medicine is prescribed to relax the bladder or tighten the sphincter muscles.
• Surgery
• For men: operation to relieve the blockage caused by an enlarged prostate.
• For women: operation to restore the support of the pelvic floor muscles, or to reconstruct or compress the sphincter.
• An artificial urinary sphincter can replace a damaged or absent sphincter muscle.
• Absorbent products and devices.
• Timed voiding: gradually increases the interval between voids
• Kegel exercises: for both urge and stress, improves ability of pelvic muscles to control leakage
• Biofeedback: extension of Kegels. Helps patients focus on pelvic floor muscles
• Electrical stimulation: electrical stimulation of pelvic floor muscles. Carried out with biofeedback
• Extracorporeal magnetic innervation:
  • The Neotonus Chair, electromagnetic stimulation of the pelvic floor muscles
• Medications: drugs are available to inhibit bladder contractions in urge incontinence. Drugs are also available to tighten or relax the bladder neck
• Catheterization: If the bladder does not empty, patients may evacuate their bladders by catheterizing themselves

• Successful procedures available if simple measures don't work e.g.
  
  • Slings and suspension procedures
    
    • If you undergo surgery using GYNECARE TVT Tension-free Support for Incontinence, your surgeon will restore the normal position of the urethra by weaving a "sling" of mesh tape beneath it.
    • After surgery, the tape will support the urethra during a sudden movement such as a cough or sneeze. This allows the urethra to remain closed and prevents the involuntary loss of urine.
  • Peri-urethral bulking agents
  • Artificial sphincters
    • Artificial Urinary Sphincter prosthesis is a small, inflatable device. The cuff is filled with fluid and gently squeezes the urethra closed to keep urine in the bladder.
  • Pelvic floor stimulators

Jennifer G. Rothschild, M.D., M.A./M.P.H.
Associate Professor

• Consult your physician.
• Incontinence is a treatable condition.
• For more information, call the UC Davis Urologic Surgery Clinic at (916) 734-2222 or (800) 770-6930.