Urinary Incontinence and Overactive Bladder

     An estimated 13 million adults of all ages suffer from urinary incontinence; women account for nearly 85 percent of cases. Women of all ages are at risk for urinary incontinence, from athletes in their midtwenties and women of childbearing age, to women experiencing menopause in middle age and women aged 60 an older.

Urinary incontinence is most often classified into four categories:

• Stress – the involuntary loss of urine during physical activities such as coughing, sneezing, laughing, exercising or other ordinary movements.
• Urge (Overactive Bladder) – an abrupt and uncontrollable desire to void the bladder.
• Mixed – a combination of urge and stress urinary incontinence.
• Overflow – the involuntary loss of urine resulting from an overfilled bladder without any corresponding feeling or urge to void.

Stress Urinary Incontinence

     Stress urinary incontinence is presumed to be the most prevalent type of incontinence. Causes of stress urinary incontinence [may] include: pregnancy and childbirth, constant coughing (such as with bronchitis), being overweight, gynecological surgery, and aging.

Treatment Options for Stress Urinary Incontinence

• Oral medications
• Bulking agent injected to directly around the urethra to help it close to prevent leakage of urine
• Surgery to repair or lift the urethra and bladder neck to prevent slippage during straining or sudden movement
• Kegel or pelvic muscle strengthening exercises

Urge Incontinence (Overactive Bladder or OAB)

     An overactive bladder is a condition that results from sudden, involuntary contraction of the muscle in the wall of the urinary bladder. Overactive bladder causes a sudden and unstoppable need to urinate (urinary urgency). Overactive bladder is also referred to as urge incontinence and is a form of urinary incontinence (unintentional loss of urine).

Treatment Options for Urge Incontinence or OAB

• Behavior modification which includes drinking less fluids, avoiding caffeine, alcohol or spices, not drinking at bedtime and urinating around the clock and not at the last moment.
• Kegel exercises or exercising the pelvic muscle
• Oral medications that relax the bladder
• Interstim, which is a new and exciting technology that involves the use of a bladder pacemaker to control bladder function. This technology consists of a small electrode that is inserted in the patient's back close to the nerve that controls bladder function. The electrode is connected to a pulse generator and the electrical impulses control bladder function. There is more than 60 to 75 percent cure or improvement with this technology.

Treatment Options for Overflow Incontinence

     For overflow incontinence, the treatment is to completely empty the bladder and prevent urine leakage. Patients with diabetes or patients with prostate obstruction can develop this type of incontinence. Overflow incontinence due to obstruction should be treated with medication or surgery to remove the blockage. If no blockage is found, the best treatment is to instruct the patient to perform self-catheterization a few times a day. By emptying the bladder regularly the incontinence disappears and the kidneys are protected.