Incontinence

Urinary incontinence in women can be troublesome and not easy to talk about, but luckily, there are treatment options available. There are several types of female incontinence, but the most common of these are urinary urge incontinence, stress incontinence, and in some cases, a combination of both. Incontinence is a common condition in women and is more likely to develop as the woman ages.

Diagnosis

The diagnosis of urinary incontinence in women includes a detailed history and physical including when the patient began to experience the symptoms and how frequently they occurred. Your doctor may also choose to evaluate your urethra with a variety of office tests that may include:

  • Post-void residual volume: this determines how well you empty your bladder
  • Urinary flow rate: the strength of your urinary stream
  • Retrograde urethrogram: an x-ray performed while instilling dye into urethra
  • Cystoscopy: using a small telescope to examine the urethra and bladder

Female Urinary Urge Incontinence

Urinary urge incontinence involves the involuntary loss of urine usually associated with a sudden urge that cannot be suppressed. Some of the causes may be related to infection, hormone status, childbirth, or previous pelvic surgeries. A thorough history and comprehensive pelvic floor exam are vital to determining the root cause of this condition. Not only is it important that the physician knows all of the medications that the patient is taking, but it is equally important to know the toilet and dietary habits of the patient as well.

Urinary Urge Incontinence can become a serious issue by certain types of foods and beverages. A urinalysis should be performed so that the physician can rule out an infection as the cause. Further testing either with urodynamics or cystoscopy or, in some cases, both may be needed in order to make an informed conclusion.

Treatments for Urge Incontinence

Non-Invasive

  • Behavioral Changes- Weight loss, if you have stopped smoking, and pelvic floor muscle therapy
  • Botox- An in-office treatment that uses Botox to calm the nerves that trigger the overactive bladder muscles, that cause incontinence
  • Dietary Changes
  • Pharmacological- This involves a trial of medications that are known as anticholinergics. It is important that the patient is aware of the side effects of medications. If the medications are not helpful or cannot be taken, then other surgical modalities are investigated
  • Physical Therapy- Pelvic floor muscle therapy

Minimally Invasive

  • InterStim – This therapy uses a small, implanted medical device to send mild electrical pulses to a nerve located just above the tailbone. This nerve, called the sacral nerve, controls the bladder and surrounding muscles that manage urinary function. The electrical stimulation may eliminate or reduce bladder control symptoms. InterStim therapy does not treat symptoms of stress incontinence.

Female Stress Urinary Incontinence

Stress incontinence is the involuntary loss of urine associated with physical activity such as coughing, sneezing, and exercising. It is caused by several factors, some of which may be childbirth and previous pelvic surgeries. As many as 50% of all women experience symptoms of stress urinary incontinence at some point in their life. As with urinary urgency incontinence, a thorough history and physical exam is crucial in determining the cause and a treatment plan moving forward.

Treatments for Stress Incontinence

Non-Surgical

  • Kegal Exercises to strengthen the pelvic floor
  • Dietary Modification / Times Voiding

Surgical

  • Sling- Safe and effective with a high, long-term success rate, and is usually done in an outpatient setting
  • Bulking Agents- Injected into the urethra, which can be done in the office

Small fistulas may sometimes resolve with a Foley catheter drainage. However, the majority of times, surgical treatment is needed. Depending on the location of a fistula, the physician may repair the defect either vaginally or abdominally. Trained physicians can repair this robotically, which greatly minimizes post-operative discomfort and recovery time.

Urethral Stricture Symptoms

  • Blood in the urine
  • Difficulty urinating
  • Frequent urination
  • Painful urination
  • Spraying of the urinary stream
  • Discharge from the urethra

Diagnosis includes a detailed history and physical including when the symptoms started and the degree of their severity. Your doctor may also choose to evaluate your urethra with a variety of office tests including:

  • Post-void residual volume: determining how well you empty your bladder
  • Urinary flow rate: strength of urinary stream retrograde urethrogram: X-ray performed while instilling dye into urethra
  • Cystoscopy: looking into the urethra and bladder with a small telescope

Urethral Stricture Treatments:

Various treatment options exist, each with their own advantages and disadvantages. Your physician can assist in determining which is the correct choice for your needs.

  • Urethral Dilation

    : Gently stretching the stricture with sequential dilators. Usually performed in the office with local anesthesia, however recurrence rate is high.

  • Endoscopic Incision

    : The stricture is cut using a special cystoscope while under general anesthesia in the operating room. Typically performed on an outpatient basis, and no formal skin incision is needed. Success rate is typically pretty good, but depends on the location of the stricture and length of the stricture. Each subsequent incision carries higher recurrence rate.

  • Open Urethroplasty

    : Removing the diseased segment and replacing with healthy tissue. The technique used depends on location and length of the stricture, as well as the experience of the surgeon. For longer strictures, a tissue graft is commonly needed to bridge the gap. The tissue used for grafting can include local penile skin or buccal mucosa from inside the cheek. Success rates are typically very good with low recurrence rates, especially with surgeons with experience in performing these procedures.

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