Urinary Incontinence

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  • 8 Answers
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    There are a number of causes for urinary incontinence, including some of the following:

    • The continence mechanism - Normally the vagina gives support to the bladder when pressure from a cough, laugh, or sneeze reaches the pelvic floor; pressure is then distributed equally around the bladder and urethra. The pressure on the urethra helps close the urethra against the support of the vagina and keeps the urine in the bladder.
    • Bladder neck mobility - Through damage to the pelvic floor muscle or aging, the pelvic floor no longer supports the pelvic organs. Therefore the bladder will rotate down, causing urine to leak out of the bladder.
    • Sphincter deficiency - Prior surgery, radiation treatment, or injury to the nerves of the pelvis can cause this condition. The support of the pelvic floor may be normal, but the internal muscles cannot keep the pressure of a cough, laugh, or sneeze may cause urine to leak out.
    • Overactive bladder disorders - Normally the bladder must remain relaxed and fill to capacity. When the bladder is full, it starts to contract, which allows the bladder to empty. When a person suffers from this disorder, the bladder does not respond to these typical signals and needs to empty out frequently.
    • Fistulas and diverticula - These are abnormal connections from the bladder to the vagina. This can be the result of a previous infection, or from surgery. A fistula allows urine to bypass all normal mechanisms of storage and release, so you will experience constant urine leakage.
    • Functional incontinence situations - When the urinary tract functions normally, but due to other reasons, the normal continence mechanisms are overcome and the balance tips in favor of incontinence.
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  • 2 Answers
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    Nocturia is a condition in which you must get up at night to urinate. This may involve one or more trips to the bathroom. While nocturia affects men and women of all ages, it becomes more common as people get older. Nocturia is actually one of the main causes of sleep problems in adult men and women. Getting up multiple times is called nocturnal polyuria.
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  • 1 Answer
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    A , Urology, answered
    Common situations that may result from urinary incontinence include, but are not limited to:
    • Depression
    • Falls
    • Financial hardship
    • Hospitalization
    • Increased home care services (Caregiver stress)
    • Loss of Independence
    • Nursing home placement
    • Skin breakdown
    • Social isolation
    • Reduced quality of life
    We will focus primarily on social isolation and loss of independence. 
    Women (and men) who suffer with urinary incontinence are reluctant to socialize, exercise, travel, and perhaps work. Intimacy may be totally avoided. The result may be social and/or emotional isolation and a lack of desire to visit family and friends because they are afraid to have an “accident” in public. Often the sufferer is too embarrassed to discuss their condition or seek help.
    Urinary incontinence may jeopardize independent living for women (and men). Managers of apartment buildings or residential hotels are reluctant to keep the incontinent person as a tenant unless public accidents, wetness and odors are eliminated. Some landlords may seek eviction or not rent units to incontinent elderly people. 
    In essence, many of the issues and situations related to urinary incontinence may result in premature nursing home placement for the affected individual.
  • 1 Answer
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    A answered
    It is very difficult to determine what is the cause of your urinary frequency as both conditions could be contributors together or individually. This has been the challenge for your doctors as well. If you feel the Proscar is not making a difference you should discuss your concern(s) with your doctor or urologist and make a joint decision on how to best manage your BPH and bladder symptoms.
  • 1 Answer
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    Incontinence is classified by both causes and symptoms. The two most common types are called urge incontinence and stress incontinence, which can present separately or in combination:

    • Urge incontinence, also called “bladder instability” or “overactive bladder,” is primarily bladder "misbehavior" and is characterized by spontaneous and uncontrolled urine leakage often accompanied by the overwhelming sensation of needing to void. Many people with this condition also have difficulty with bowel control and report frequent bowel movements or difficulties with constipation. The causes of urge incontinence are not clearly known, but is likely related to changes in the nerves controlling the bladder. Learned voiding behaviors, aging, hormonal changes, prior childbirth, previous surgery, dietary habits and other factors appear to influence this condition.
    • Stress incontinence is primarily due to weakness of the valve mechanism (sphincter) in the bladder outlet and urethra. This may be due to intrinsic changes in the urethra, or loss of support and strength of the bladder neck and adjacent structures. It is also associated with post surgical or radiation changes in men following treatment for prostate cancer. With physical exertion or activity that increases abdominal pressure, urine is forced through the deficient valve.

    Another type of leakage is termed overflow incontinence. This results from failure of the bladder to empty either from weakness, nerve injury or blockage to flow. With an overfull bladder, exertion or abdominal pressure can cause urine to spill out.

    Other conditions such as urinary tract fistulae (holes between the urinary tract and other structures), stroke, spinal cord injury and other neurologic diseases can also cause incontinence and voiding problems.

  • 1 Answer
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    Incontinence is the involuntary leakage of urine from the bladder, which can affect both men and women in any age group, but is more common in women and the elderly. As the population ages, the number of people suffering bladder control problems is increasing. The costs of this problem are personal, physical and financial, and many with incontinence suffer social embarrassment, isolation, ill health and even depression.

    The symptoms of urinary incontinence may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

  • 2 Answers
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    Therapy for urge incontinence usually begins with attempts to retrain the bladder and its behavior. Awareness and strengthening exercises are used to develop proper function of the pelvic muscles, bladder and sphincter valve. These muscles play an important role in the conscious and unconscious control of bladder emptying. These exercises are generally referred to as Kegel's exercises and require mastery of movements of the pelvic floor muscles. Retraining the bladder and voiding habits takes dedicated practice and time but is associated with a high success rate in those who expend the effort.

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    Surgical procedures for restoring continence can be performed through an abdominal incision, laparoscopically, or through a vaginal approach. The most reliable of these procedures in women are the Burch colpocystourethropexy and the pubovaginal sling. The sling procedure places a strong material beneath the urethra and bladder neck to provide strength to the sphincter valve and restore its function. Results show excellent durability with low complication rates for patients of all ages.

    For males with significant stress incontinence, surgical therapy includes placement of an artificial urinary sphincter or a supporting urethral sling. The artificial urinary sphincter is a mechanical device designed to replace the function of the weakened sphincter valve. It provides closure of the urethra on a continuous basis and is opened by squeezing a small pump implanted beneath the skin of the scrotum. This allows unrestricted voiding, after which the device closes automatically. The male sling is surgically placed beneath the urethra through an incision in the perineum (the area between the scrotum and the anus) and looped behind the pelvic bones. It lifts and supports the urethra and sphincter mechanism to lessen the forces of gravity and abdominal pressure that can cause stress incontinence. 
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    A sling operation is currently the most effective therapy for significant stress urinary incontinence in women due to weakness of the urethral sphincter. This procedure requires less than an hour of operative time and can be done as an outpatient. Through a vaginal approach, a small incision is made beneath the urethra to allow for placement of a strong synthetic or biologic material to provide support when pressure is placed on the bladder from a sneeze, cough, exercise or other activities.

    Results are immediate, but a healing period of modified activities is usually recommended for four to six weeks. This operation has a satisfaction rate of over 90 percent with excellent durability.

  • 1 Answer
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    The artificial urinary sphincter (AUS) is an implantable device used to treat stress incontinence in men. There are three components:  a fluid filled reservoir roughly the size of a golf ball that is implanted in the groin area next to the bladder; a pump device about the size and shape of the thumb is placed inside the scrotum in front of one of the testicles; and a circular inflatable cuff that is placed around the urethra and sphincter area.

    When activated, the cuff compresses the urethra with sufficient pressure to withstand forces associated with most activities. When one has the usual sensation of a full bladder, the pump in the scrotum is pressed between the fingers twice to allow the cuff to open. Voiding is completed in the normal fashion and the device automatically closes over one to two minutes. Implantation of this device generally requires 60-90 minutes and an overnight stay in the hospital. The device is left inactivated for a period of four to six weeks following implantation to allow for successful healing and recovery. After this waiting period the device, is turned on and results are immediate.

    The AUS usually provides an improvement in quality of life in the majority of men with significant stress urinary incontinence.