HOW COMMON IS INCONTINENCE?
Incontinence affects approximately 10 million Americans, without regard of sex and age. That means one out of every 25 Americans suffer from some type of incontinence. Incontinence is more common in women than in men.
WHY SEEK HELP?
Besides the social stigma of embarrassing odor and wetness, skin may be damaged by urine. With the technology of the 90s, most incontinence can be treated or at least managed to allow full participation in a satisfactory lifestyle.
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Urinary incontinence is defined as the unwanted loss of urine. Many women are too embarrassed to ask for help, and many women don't realize that successful treatment is usually available for most of these patients. Urinary incontinence is not a necessary part of aging, and can happen in young women as well as old and often can be treated. There are actually many different types of incontinence, and the successful treatment of incontinence depends on making the most accurate diagnosis of the type of incontinence that is affecting each individual patient.
The major types of incontinence are:
URGE INCONTINENCE, which means that the woman loses urine when she feels a strong urge to go to the bathroom, but cannot get to the bathroom quickly enough. This is also associated with the urge to urinate when drinking even small amounts of liquids, or associated with severe frequency of urination, day or night, and even associated with bedwetting.
The second type of incontinence is STRESS INCONTINENCE, which means that patients will have unwanted loss of urine when they exercise, or have any sudden movements such as coughing or sneezing or laughing. It can be from any type of exercises, including simply getting out of a chair or walking.
The last type of incontinence is OVERFLOW INCONTINENCE in which the patients have a very poorly emptying bladder, and the urine leaks out uncontrollably often in very small, frequent amounts. In many patients the types of incontinence seem to run together.
EVALUATION
Factors that need to be evaluated in any woman with incontinence is the presence of:
Urodynamics is an in-depth evaluation of the structure (anatomy) and function of lower urinary tract (bladder and bladder outlet channel or urethra). These studies are important in diagnosing problems of loss of urinary control or frequency of urination and other urinary problems. The urodynamic evaluation is different in every patient and for each diagnosis. The tests may evaluate the physical structure of the bladder, using X-rays and telescopes, and evaluate the nerves and muscles that control the function of the bladder. These tests are not painful !
Cystoscopy
Cystoscopy is a procedure that is used to visually inspect the bladder and the urethra (tube leading out of the bladder). In most instances this can be done without discomfort by the use of a local anesthetic jelly (not a shot)!! The cystoscope or telescope is passed into the bladder and the inspection is carried out. Ask if you have questions--it's not as bad as you think--honest!
Cystometrogram (CMG) or Cystometry
The cystometrogram or CMG is a study of the pressure and sensation of the bladder as it fills. A small tube or catheter is placed into the bladder. The bladder is then slowly filled with water. As the bladder fills, you will first develop the sensation of filling, followed by the sense of the need to urinate and then a definite need or urge to urinate. We will note the exact volume of filling for each of these events and the pressures in the bladder throughout the study. You will then be asked to try to urinate and we will measure the amount of pressure or strength that your bladder muscles can create.
Video cystogram (fluroscopy)
The video cystogram is a special motion picture x-ray of the urinary bladder and urethra. A small catheter is placed into the bladder and a clear iodine-containing dye is instilled. You will be asked to strain and / or void while the video x-rays are being taken. Information about bladder configuration and emptying will be obtained. We also look for urinary reflux -- that is passage of urine backwards into the kidney during voiding.
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