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Incontinence Educational Brochure
The kidneys filter the blood to make urine and get rid of body wastes. Urine flows down tubes calls ureters to the bladder where it is stored. When you are ready to go to the bathroom, the bladder contracts, urethral muscles relax and urine flows out of the body through the urethra.
Causes of Incontinence
Incontinence is a symptom that can be caused by many conditions. There are four main types of urinary incontinence.
- Stress incontinence is the loss of urine during coughing, laughing, or other physical activities that increase abdominal pressure. This may be due to poor bladder support from multiple child births, or from a weakened urethral sphincter at the base of the bladder.
- Urge incontinence is the loss of urine with a sudden and severe desire to void. This occurs when an overactive bladder contracts without your wanting to do so. People with urge incontinence often have to void frequently.
- Overflow incontinence occurs when the bladder becomes so full that it simply overflows. This happens with bladder weakness or a blocked urethra prevents normal emptying.
- Transient incontinence results from something that often can be easily reversed. Causes include urinary tract and vaginal infections, severe constipation, side effects of medications (water pills), and restricted mobility.
Sometimes incontinence can be a mixture of more than one of the four types.
Evaluation
The standard evaluation of incontinence consists of the following:
- Detailed history and physical
- Urinalysis to look for signs of infection, blood, or other abnormality
- Post void residual (PVR) which measures how much urine is left in the bladder after voiding by placing a small tube into the bladder or by using ultrasound (sound waves)
- Stress test which looks for urine loss when stress is put on bladder muscles, usually by coughing, lifting, or exercise
A more detailed evaluation may require one or more of the following:
- Voiding diary which is a record of how often you pass urine, how much each time and how often you leak
- Urodynamic testing which examines bladder and sphincter function. It involved putting a small tube in the bladder and asking you questions while slowly filling up the bladder and measuring bladder pressure. X-rays are used to see the bladder (cystogram).
- Cystoscopy, a procedure that allows your doctor to directly examine your urethra and bladder through a small telescope-like tube
- IVP (Intravenous pyelogram), an x-ray of the urinary tract (kidneys, ureters, bladder, urethra). It involves the injection of a special substance called contrast, which is filtered by the kidneys and helps visualize the urinary tract.
Treatment
There are three main types of treatment for incontinence. The best treatment for you depends on the specific type of incontinence.
- Behavioral techniques teach you ways to control your own bladder and sphincter muscles. The most common methods are pelvic muscle exercises (kegels) and bladder training. Approximately 50% of patients receiving this treatment perceive an improvement, and 15% are cured of their incontinence.
- Medications can help certain kinds of incontinence. The most common types of medications stop abnormal bladder contractions, treat infection, replace hormones, or tighten sphincter muscles. As many as 77% of patients receiving this treatment are significantly improved, and 44% are cured.
- Surgery can be performed to restore the bladder to its normal position. In some patients with incontinence, a mid-urethral sling may be needed to prevent incontinence due to a weak bladder sphincter. Sometimes injection of a substance call Contigen can cure incontinence. Approximately 78% to 92% of patients who need surgery to treat their incontinence are cured.
Summary
Incontinence is a problem that affect one’s emotional, psychological, and social bell being. It can make people feel afraid to participate in normal daily functions so that they can have a normal life.
The majority of incontinence can be treated successfully.
References
Romanfi. Blaivas; Preliminary Assessment of the Incontinent Women, Urological Clinics of North America, Augusta 1995, pages, 513-520.
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