Urgency Incontinence
Your chief symptom is urgency or urgency incontinence. Urgency is defined as the uncontrollable and sudden desire to urinate. Urgency incontinence is the sudden loss of urine associated with urgency. The symptom of urgency can be due to an underling bladder problems and the urologist (who is a specialist in the urinary tract disease ) is best the best trained to evaluate this symptom.
It will be important for you to fill out a voiding diary and incontinence questionnaire prior to your appointment to help sort out you problem of urgency. In the diary you will record your daily fluid intact, voided urine volumes, and your incontinent and urgent episodes. By completing this diary your doctor will have a better understanding of your problem.
Evaluation:
To evaluate your incontinence certain exams and tests will need to be performed. These tests will help to assess the type of incontinence you are experiencing in order to advice the best treatment. Other types of incontinence such as stress and overflow are common and will not be discussed here.
- A pelvic examination will be performed to assess the degree of pelvic floor relaxation. Other pelvic problems such as fallen bladder (cystocele), or fallen bowel (rectocele) can be assessed. The men will have a prostate exam to evaluate the gland for enlargement or nodules.
- A urinalysis will be performed.
- A residual urine will be checked with the ultrasound scanner.
Depending on the results of these studies other studies may be performed at this visit or scheduled for a later time.
- Urodynamics are a series of tests designed to evaluate the function of the bladder. The tests are performed by placing a small tube into the bladder and filling the bladder with sterile water.
- Cystoscopy is a look into the bladder with a small soft flexible telescope placed through the urethra. This allows the urologist to view the interior of the bladder to check for intrinsic bladder problems.
- Radiological studies may be performed at the hospital to evaluate the upper urinary tract or bladder.
These tests should provide the urologist with the necessary information to determine your problem and advice appropriate management.
Urgency incontinence is commonly due to a hyperactive,unstable or hyper reflexive bladder.
The most common types urgency incontinence include:
1. Bladder changes due to aging and prostatic hypertrophy ,
2. Neurological disease such as multiple sclerosis, stroke, Parkinson's or spinal disease.
3. Irritation in the bladder due to infection or tumors.
4. Anatomic deformity such as a cystocele.
Urgency as the only symptom can be due to the same causes but also can be due a small capacity bladder, urethritis, or stone in the urinary tract.
Management:
Urgency Incontinence is best treated with a combination of bladder and pelvic exercises through biofeedback, medications Electric stimulation or sanitary pads . Bladder and pelvic exercises will be directed toward increasing your functional bladder capacity. Functional bladder capacity is the amount of urine your bladder can hold without resulting in urgency or incontinence. This amount can be determined through your diary by recording the amount of fluid you drink and the amount you void.
- Biofeedback has been effective in the treatment of urinary incontinence and pelvic muscle dysfunction in people who are willing and able to assume more responsibility and control of their body. Retrain your Bladder Don't let your bladder control you; Follow these steps to improve your bladder control. It requires your active participation:
1. Resist or inhibit your sensation of urgency, try postpone voiding when you feel that first urge.
2. Urinate according to a timetable rather than waiting till you develop the urge to void. Time your voiding by the clock; you must learn to void at 2-3 hour intervals during the day. We already know your functional bladder capacity from the voiding diary you filled out earlier. By knowing the amount of fluid your bladder holds prior to developing the urge to void, you can judge the time interval necessary to urinate in order to stay dry.
3. Restrict or reduce the amount of fluids you drink during the day. Obviously the more fluid you consume; the more frequently you will need to urinate. Measuring the amount of fluid you drink and knowing how must you bladder fills will allow you to judge the functional bladder capacity. This is the point at which you bladder triggers to contract unavoidably. This amount varies from person to person but can range from 1-4 cups. Should the urgency to urinate occur at a small bladder volume then the more fluid you drink the more frequently you will need to urinate.
- Medication: The usual medication used for treatment of urgency incontinence is oxybutynin (ditropan) or hyoscyamine (Azospaz). These medication work to improve the urine retaining ability by decreasing the bladder spasticity by diminishing the bladder tone. There side effects include constipation, dry mouth and eyes, and possible flushing.
- Electric Stimulation: (E Stim) has shown promising results in many individuals with urgency, frequency and incontinence. This requires the purchase of a small vaginal probe, and stimulator that delivers a tiny electric shock to the urethra. This causes incresed tone to the bladder neck and aids in inhibiting the bladder contractions.
To aid you in preventing incontinence if you feel a sudden urge to void:
1. Stop what you're doing and stand still.
2. Tighten your pelvic muscles to try and hold the urine from leaking out.
3. Wait till the urge resolves before resuming your activity.
Even with many different treatments, you still may have episodes of intermittent incontinence. Sanitary pads are currently available in a variety of sizes and shapes. It may be necessary to have pads available for trips or situations where a rest room will not be readily available.
