Urinary Tract Issues

Don't be embarrassed to be looking for more information about incontinence issues. Urinary incontinence affects as many as 17-25 million Americans. Experts estimate that greater than 12 billion dollars is spent each year on incontinence and related problems. Approximately 85 percent of those affected with urinary incontinence are women. One out of every four women between the ages of 30 and 59, and 50 percent of the elderly, suffers with urinary incontinence. It affects people not only physically, but emotionally, psychologically and socially. It may lead to embarrassment, social isolation and depression and prevent its sufferers from fully participating in normal daily activities.

Before you make an appointment there are a few things you can do to get the most accurate diagnosis:

1. Prepare to discuss this problem with your physician by paying special attention to:
· Conditions and events that lead to bladder control problems
· The frequency of urination
· How often you experience uncontrollable urges to urinate
· The amount of leakage that occurs with each episode, if any
· The amount and types of fluid you drink everyday
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2. Make sure you obtain records from your primary care provider prior to visiting an incontinence specialist.

3. Keeping a voiding diary for as little as three days can assist you in obtaining this information. You may pick one up from our office or make your own. Corresponding to times throughout the day, you will want to write down each time you drank and how much; each time you ate and how much; the times you felt the urge to urinate; when you urinated and about how much; when you leaked, what you were doing and how much; and the number of pad changes you made, noting what kind of pad.

Common Conditions in Women

Women who come to The Woman’s Clinic have a variety of conditions including:

Women who come to The Woman's Clinic experience a variety of symptoms, including the following:

• Incontinence
• Urinary frequency and/or urgency
• Urinary tract infections
• Overactive bladder
• Neurogenic bladder
• Nocturia
• Voiding problems
• Urethral diverticulum
• Pelvic prolapse/pelvic surgery
• Interstitial cystitis
• Constipation

The condition known as urinary incontinence is subdivided into 4 typical types:

Stress Incontinence

Leakage of urine with coughing, sneezing, laughing or any other activities that increase the pressure on the bladder and/or the supporting tissue. Stress incontinence is related to the weakening of the muscles surrounding the bladder and urethra (the tube urine comes out of) or damage to the urethra causing it to remain open.

Urge Incontinence

The inability to get to the bathroom in time to prevent leakage of urine. People have usually little or no warning that the bladder needs to empty. Urge incontinence is related to numerous factors, including dietary, neurological and behavioral characteristics.

Mixed Incontinence

A combination of urge and stress incontinence.

Overflow Incontinence

The involuntary loss of urine that occurs when the bladder fails to empty any significant amount. It constantly fills and over flows. Diabetes and neurological diseases are often contributing factors to overflow incontinence.

Assessment

Assessment of your condition may include one or more of the following:

We have numerous ways to determine the root cause of your discomfort. We will use any combination of the following in working with you.

Pelvic floor muscle assessment
Cystoscopy
History
Physical
Pelvic examination
Urinalysis
Urine culture
Post void residual
Office urodynamics (cystometrogram, uroflow, UPP, voiding pressure study)
• Referral to on site dietician and psychologist

Treatment

Once your physician is able to diagnosis the particular condition that is causing your discomfort there are many options for treatment; including:

Noninvasive Therapies:
• Bladder retraining
• Toileting programs (habit training, prompted voiding)
• Pelvic floor muscle rehabilitation
• Dietary management
• Fluid management
• Constipation prevention/management
• Patient education

Rehabilitation Therapies:
• Pelvic floor muscle rehabilitation using biofeedback (Referral to Physical Therapy)
• Intermittent catheterization instruction

Devices:
• Fitting of devices (intermittent catheterization, catheters)
• Pessary placement

Drug Therapy:
• Anticholinergic/OAB drugs
• Antibiotics
• Topical estrogen
• Alpha blockers
• IC treatments
• Elmiron
• Bladder instillations

Surgical Interventions:
• Stress urinary incontinence surgery
• Sub-urethral sling procedures
• Transobturator sling surgery
• Synthetic mesh
• Pelvic organ prolapse surgery
• Injection of urethral bulking agents
• Interstim sacral nerve implantation
• Interstim for urge incontinence
• Hydrodistension for IC
• Urethral diverticulum surgery

Other Treatments:
• Indwelling catheterization
• Skin care product recommendations and care
• Absorbent products and devices recommendations
• Referrals for dietician, psychologist, and physical therapy