Urinary Incontinence
Urinary Incontinence is the involuntary loss of urine is a frequent problem, and can be subdivided into certain categrories. Some of the more common types include:
- Urge Incontinence is the result of a bladder contraction, that gives an urgent sense to urinate just before the leakage. The most common cause is a urinary tract infection; however, overactive bladder (OAB), bladder tumors or stones, interstitial cystitis or some neurologic conditions (stroke, dementia, Multiple Sclerosis, Parkinsons) can also be to blame.
- Stress Incontinence is when leakage occurs with physical activity (sneezing, laughing, lifting) but without the urge to urinate. This usually occurs in women with weakened pelvic muscle floor support, but can occur in men who have had prostate surgery.
- Overflow Incontinence is suspected when a person has a weak stream, voids small volumes and begins to wet themselves in bed, and is due to the bladder being “over filled.” Underlying causes can be prostate obstruction, diabetes, some neurologic conditions and certain medications (especially anticholinergics).
- Nocturnal Enuresis usually refers to involuntary bed-wetting that occurs in children. It is common and is thought to be a benign developmental lag in the nerves that control bladder function.
The diagnosis is made by a history and physical exam. Sometimes certain labs are necessary, including urinalysis and culture, measuring postvoid residual urine by an ultrasound, cystoscopy (a look in the bladder with a special scope) and a urodynamic study.
The following are common treatments for the various types of incontinence:
- Urge incontinence is usually treated with medications (anticholinergics) such as Detrol, Ditropan, Sanctura, Vesicare and Enablex.
- Stress incontinence can be treated with bladder neck injections of collagen, or retropubic slings and suspensions.
- Overflow incontinence will initially need catheterization, and men may benefit from a prostate procedure.
- Nocturnal enuresis generally resolves by age 6, but there are a variety of treatments such as medication (DDAVP, Impipramine) or bedwetting alarms.
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