Urinary incontinence may occur in males and females and is defined as an involuntary loss of urine sufficient to be a problem for the patient. Capital Region Urology physicians will get a complete history and do a physical examination to evaluate the degree of urinary incontinence. The physician may also do additional testing such as a complex urodynamic study to better characterize the nature of urinary leakage and overall bladder function. In this study, the bladder is filled at a predetermined rate and bladder pressures are continuously measured. The patient may be asked to cough and strain during the study, and will often ingest fluids to measure the bladder's capacity, ability to empty, and the voiding pressure.
Stress Urinary Incontinence
Stress urinary incontinence (SUI) is the loss of urine with increases in intra-abdominal pressure, as with coughing or sneezing. This may be secondary to urethral sphincter insufficiency, as in anatomic prolapse or sphincter injury. When there are significant symptoms, and sophisticated urinary bladder pressure studies confirm stress urinary incontinence, the Capital Region Urology physician may recommend a bladder neck suspension procedure to relieve the problem. âï¿½¨
Urge Urinary Incontinence
Urge incontinence is defined as the loss of urine associated with the urgent need to urinate. This condition is usually characterized by the patient indicating an inability to "hold it" when feeling the urge to urinate. In many cases, sophisticated bladder testing will find no significant underlying disorder, and a patient will be treated with medical therapy. It is important to rule out related neurologic and medical disorders.
Capital Region Urology physicians will sometimes treat urinary incontinence with diet modification, having patients avoid liquids before bedtime, or by changing medications that may be causing the problem. Sometimes infection or illness inhibits a patient's ability to control bladder function; in these cases more aggressive treatment may be needed. Non-invasive outpatient procedures, biofeedback, medications and surgery are among several options.
Suspension and Sling Surgery Procedures
Suspension and sling surgical procedures may achieve bladder control for other causes of incontinence. For example, stress urinary incontinence can be triggered when someone is straining, coughing or sneezing. There are several types of slings, including the pubovaginal sling, the midurethral retropubic sling and transobturator slings, which support the urethra and help maintain bladder control.
With interstim neuromodulation therapy, Capital Region Urology, Institute for Pelvic Medicine, physicians can bring relief to women suffering from bladder pain or who feel a frequent need to urinate. Interstim neuromodulation (or simply neuromodulation) therapy controls the nerve endings to reduce the constant urge to urinate.
Neuromodulation works in nearly the same way that a pacemaker modulates a person's heart rate. Surgeons implant a device with tiny electrodes, and the device emits electrical impulses to stimulate the nerves in the sacral (lower back) area. This inhibits the hyperactive signals from the sensory nerves within the bladder wall and improves symptoms. If this treatment is successful, the electrodes may be permanently installed for up to nine years of effective treatment.