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Incontinence
Overactive Bladder Clinical Trial

Bladder control problems range from urinating too frequently to actual urine leakage (urinary incontinence). These problems affect millions of people of all ages and both sexes. Unfortunately, many people feel so ashamed that they may even hide their problem from their doctor. If your incontinence interferes with your daily life, seek help promptly. Our experienced urologists can recommend many new treatments to cure or manage your problem, letting you resume a normal life free from worry and shame.

There are several types of incontinence and some people experience more than one kind.
  • Urge Incontinence (Overactive Bladder) - in this type, urine leaks when the bladder inappropriately contracts, and you may not be able to get to the bathroom quickly enough.
  • Stress Incontinence - this type is most common among middle aged and older women. Exercising, coughing, sneezing or other activities put pressure on a weakened bladder sphincter and cause leaks.
  • Overflow Incontinence - in this type, which mostly affects men, you don't feel the urge to urinate, your bladder doesn't empty well and small amounts of urine may leak continuously.

Urge Incontinence (Overactive Bladder)


Symptoms
  • A sudden, strong urge to urinate
  • Inability to get to the bathroom in time
  • Frequent need to urinate, including at night
  • Feeling the urge to urinate when you hear water running
  • Leaking urine when you stand up after sitting

Causes
  • A diet high in bladder irritants such as coffee, tea, chocolate or acidic fruit juices
  • Urinary tract or vaginal infections
  • Bowel problems
  • Some medications
  • Damage to the nervous system caused by Multiple Sclerosis, Parkinson's disease, Alzheimer's disease, stroke or other medical problem

Stress Incontinence


Symptoms
  • Urine leaks when lifting heavy objects, exercising, coughing, sneezing, etc.
  • Problems worsen when your bladder is full

Causes
  • Childbirth
  • Menopause
  • Removal of the prostate or bladder surgery

Overflow Incontinence


Symptoms
  • Your bladder is never completely empty
  • Frequent need to urinate day or night
  • Inability to urinate when you feel the urge
  • Urine leaks even after voiding

Causes
- usually a blockage or nerve damage created by one of the following:
  • Benign prostatic hyperplasia (BPH) - an enlarged prostate can interfere with the passage of urine through the urethra, the tube connected to the bladder
  • Damage to nerves near the bladder causing under-activity. This can occur with neurological injury or with diseases such as diabetes.
  • Urinary stones or bladder cancer
  • Side effects from medication

Diagnosis

The first step is a thorough history and physical by your doctor, who will examine your abdominal and genital area carefully. Additional tests may include:
  • Bladder diary - your doctor may ask you to keep a record of what you drink and your urine output
  • Urinalysis
  • Blood tests

More specialized tests that your urologist may perform include:
  • Postvoid residual test (PVR) - your doctor can determine how well you empty your bladder by using an ultrasound (most common) orby inserting a catheter into your urethra and bladder to determine the amount of leftover (residual) urine. A large amount may indicate a blockage, or a nerve or muscle problem.
  • Pelvic ultrasound - painlessly checks for abnormalities in the bladder,urinary tract or genitals.
  • Stress test - your doctor looks for leaking urine when you cough or bear down.
  • Urodynamic test - a simple office test that helps determine the best treatment plan by assessing how your bladder functions and why you are having problems.
  • Cystogram - a special X-ray of your bladder.
  • Cystoscopy - a tiny instrument called a cystoscope is inserted into the urethra to look for and possibly remove abnormalities.

Treatment

Treatment will depend on your type of incontinence and its cause.Thankfully, most people can be treated successfully, allowing them to enjoy a normal life again. Your doctor may start with less invasive treatments first, such as behavioral changes or medication, and then use medical devices or surgery if other treatments don't adequately address your incontinence. Blockages usually must be treated surgically; however, those caused by prostate enlargement maybe treated with medication.

Lifestyle Changes (improvement may take time)
  • Fluid and diet management - avoid caffeinated or tomato-based food and drink, and drink adequate water
  • Bladder retraining - follow a schedule for bathroom trips and gradually increase the length of time between them to improve your bladder control
  • Pelvic floor (Kegel) exercises - learn techniques to strengthen your pelvic muscles
  • Biofeedback - can help you determine when you're exercising the right muscles
  • Special absorbent pads and underwear - these have improved in recent years and can help you feel more confident, especially while undergoing diagnosis and initial treatment

Medications
  • If you have urge incontinence, your doctor may prescribe anticholinergic drugs to relax your bladder muscles.
  • If you urinate frequently at night, you may need a medication that helps your body make less urine at night.

Non-surgical Devices
  • Electrical stimulation devices - electrodes may be placed temporarily in the rectum, vagina or behind your ankle to painlessly strengthen the pelvic floor muscles.
  • Urethral plugs and pessaries - a woman with stress incontinence inserts a plug into her urethra when she wants to stop urine leakage,or a health professional inserts a pessary (rubber ring) into the vagina to reduce leakage.

Surgery and Implanted Devices
  • Bulking agent - for stress incontinence, your doctor may inject a thick substance called a bulking agent into the area around the bladder to support it. This outpatient procedure takes about 5-10 minutes.
  • Electrical device - may be implanted into the tailbone area to control urine flow.
  • Sling surgery - a minimally invasive surgery that takes about 20-30minutes. A piece of your own tissue or a synthetic material is used to support the bladder neck and urethra.
  • Radiofrequency bladder neck suspension - a minimally invasive procedure in which the pelvic tissue is gradually and precisely heated, allowing it to shrink and stabilize to keep the urethra from leaking.
  • Retropubic suspension - your surgeon attaches the bladder to structures behind the pubic bone to provide more support. This can be done laparoscopically.