Take Control of Your Bladder
A unique online community dedicated to encouraging people with bladder control problems to seek help rather than suffer in silence. We promote understanding of bladder control problems and awareness of the latest treatment options. Is your bladder controlling your life?
Track your urinary episodes, fluid intake, medication usage, and more. Review your progress with graphs and reports that you can print and share with your healthcare provider.
Learn more about bladder control problems, including where to seek help, treatment options, and lifestyle issues.
About Bladder Control ProblemsBladder control problems are classified into a number of different types:
Urge Incontinence is typically experienced as a sudden, strong urge to urinate. Stress Incontinence is involuntary loss of urine when the abdomen is under stress, e.g. coughing, or lifting.
Mixed Incontinence is a combination of urge and stress incontinence. Overflow Incontinence is typically experienced as a frequent dribble.
Reflex Incontinence occurs as urine loss without warning, usually in people who have suffered nerve damage. Nocturnal Enuresis or Bedwetting is incontinence that occurs during sleep.
Although bladder control problems are rarely life threatening, they impose a huge psychological and social burden on individuals, their families, and caregivers. A recent estimate of the direct costs of caring for people with bladder control problems in the United States is $11.2 billion annually in the community and $5.2 billion in nursing homes. Take control of your bladder today.
New Therapies Help Curb Incontinence
by Christopher W. Graham, MD,
and Patricia J. Terry, MD
One of the most difficult challenges urologists face is creating high success rates for incontinence treatments.
Until recently, it was common for a patient to receive therapy or undergo a procedure only to come back a few years later suffering from the same symptoms. In the past, early high success rates were followed by continence rates of 50% at the five-year mark.
Fortunately, recent strides in surgical, therapeutic, and medical treatments have improved patients’ long-term outcomes. Understanding these treatments enables healthcare professionals to treat incontinence more effectively, either by managing the problem or identifying those patients who are likely to benefit from a referral to a urologist.
The insertion of a transobturator tape is a highly successful, durable method of treating stress urinary incontinence. The surgeon places a narrow strip of mesh at the mid-urethra using a minimally invasive procedure. Once placed, the mesh creates a sling or a hammock that cradles the urethra and gives it a point of support. The procedure takes 15 minutes and can be performed in an outpatient setting under general anesthesia. Most patients are continent immediately following the procedure and can resume normal, nonstrenuous activities within a few days. Official data is still young, but “dry” rates of 85% have been achieved at the five-year mark.
Radio Frequency Remodeling
In 2005, the FDA approved radio frequency remodeling of the bladder neck and proximal urethra as a treatment for stress incontinence. Known commercially as the Renessa™ System, this treatment requires the physician to administer controlled heat to tissue points in the lower urinary tract using a transurethral probe. The heat denatures the tissue’s collagen and, upon healing, the treated tissue is much firmer, decreasing involuntary leakage at times of increased intra-abdominal tension.
Radio frequency remodeling can be performed safely and comfortably in the office using oral Valium® and a local anesthetic. Patients can return to normal activities immediately, making the treatment an attractive option for young women wanting to return to work or family responsibilities the next day without any restrictions.
Early data demonstrates 70% improvement in incontinence at one year. Because the procedure is new, long-term durability is undetermined. However, should the radio frequency treatment fail, patients are still eligible to receive a transobturator tape.
As pelvic surgeons now understand pelvic floor prolapse in light of modern hernia repair strategies, new devices and techniques have significantly changed management of pelvic floor prolapse and related stress incontinence.
Several new mesh products are custom shaped for pelvic reconstruction, employing anchoring arms that are tunneled through the pelvic sidewall. The durable mesh materials provide strength to support the patient’s already weakened tissue, restoring the organs to the anatomical positions. Since their introduction to the U.S. three years ago, the new procedures are rapidly becoming the preferred technique for prolapse repair.
These products are available for repair of cystoceles, rectoceles, enteroceles, vaginal vault prolapse, and uterine prolapse. If no additional uterine pathology is present, many surgeons are incorporating the uterus into the mesh repair rather than performing a hysterectomy. When compared to traditional repair techniques, the mesh techniques are faster, require less dissection, and are associated with more rapid recovery. Procedures can be performed frequently on an outpatient or 23-hour observation basis. Early indications are that they are safe and are durable.
Unlike stress urinary incontinence, which is often curable, urge urinary incontinence is more often a chronic condition resulting from an overactive bladder or the abrupt and uncontrollable desire to void. Urge incontinence is controllable with medications and pelvic floor therapy. This is especially true in older women, in whom detrusor instability is exacerbated by multiple factors of aging. Therapy to control urge incontinence is directed at addressing these factors, such as improving estrogenization (vaginal estrogens), learning to use the pelvic floor muscles effectively to guard against the bladder contraction (pelvic floor therapy), and use of anticholinergic medications.
Estrogens alone rarely cure incontinence, but they often improve the health of the tissue, enhancing the urethra’s ability to produce a water-tight seal. Vaginally-delivered estrogens may reduce detrusor instability by decreasing irritating vaginal sensitivity. Estrogens are an important adjunct for reducing the risk of bladder infections in post-menopausal women, as well. The vaginal creams work quickly when applied two to three times weekly. Alternate vaginal delivery systems such as Vagifem® and the Estring® provide more convenience for long-term management.
Pelvic Floor Therapy
Pelvic floor therapy is a method in which a patient uses a series of exercises to strengthen the muscles of the pelvic floor, therefore gaining more control over urinary leakage. Simply suggesting that someone start using these exercises (Kegel exercises being the most well-known) is as likely to be as effective as telling someone to start exercising at a health club. Unless a personal trainer demonstrates effective exercise techniques, a novice in the gym or in pelvic floor treatment is unlikely to get very far. Additionally, no amount of skilled training will help patients who are unwilling to continue exercising on their own. Thus, patient motivation is the strongest predictor of success.
In younger men and women, tightening the pelvic floor is a common stress response that most people are unaware they are doing. This may be the primary reason that many people who have detrusor instability suffer more intense symptoms when their lives are stressful. Breaking individuals of this habit is difficult, but developing exercise routines to relieve pelvic floor stress can produce dramatic improvements in bladder symptoms.
On the other hand, older women often lose the ability to contract the muscles of the pelvic floor voluntarily. When confronted with an urge, they cross their legs, contract their abdominal muscles, or grimace – none of which prevents leakage. Retraining these patients to use their pelvic floor muscles effectively requires highly motivated staff and patients.
Pharmaceuticals for Urinary Incontinence
Several anticholinergic medications have been introduced for the treatment of urgency-related urge incontinence. These medications improve bladder capacity, reduce the intensity of urgency, and have a better side effect profile than oxybutynin, a medication used to treat a variety of urinary and bladder problems. In addition, the new medicines offer a variety of dosing schedules and delivery methods.
The medications work by relaxing the smooth bladder muscle and thus blocking nerves that cause bladder contractions. Some of the side effects of anticholinergic medications include dry mouth, nose, and throat; constipation; increased heartbeat; and decreased sweating. The newer medications are better tolerated, increasing patient satisfaction and long-term compliance.
The best responses for managing urge incontinence are achieved using a multi-modality strategy. According to a recent study, anticholinergic medications, paired with behavior techniques like pelvic floor therapy, reduced urge incontinence by 85%, compared to 72% with medication alone. In other words, using a variety of methods to reduce incontinence may be better than any treatment used alone.
Dr. Graham and Dr. Terry are board certified urologists with Urology San Antonio. Dr. Graham completed a fellowship in female urology and uro-dynamics, and Dr. Terry is one of only two female urologists currently treating adults in a private practice setting in San Antonio.