Fwd: eMedicine Incontinence Feature Series Newsletter

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HEY GANG, CHECK THIS OUT! HURRY!!!

eMedicine's Incontinence Feature Series delivers the latest information.

Series 1, Issue 1

Lazarou, MD

Assistant Professor of Obstetrics and Gynecology

Division Director of Urogynecology

Weiler Hospital

Albert Einstein College of Medicine

Bronx, NY

Visit our

Incontinence Center!

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WHAT IS URINARY INCONTINENCE, AND CAN IT BE TREATED?

Urinary incontinence is the uncontrollable loss of urine. Men and women of all ages can experience urinary incontinence. An estimated 20-30% of people older than 60 years experience this condition, with women 3 times as likely to be affected as men. This condition may range from mild leakage to uncontrollable and embarrassing wetting. It is a major health problem because it can lead to disability and dependency. Urinary incontinence can be treated in 90-95% of all cases, and the number of treatment options is growing.

Causes

Many different underlying conditions can cause urinary incontinence. Contributing factors include pregnancy, childbirth, menopause, chronic constipation, asthma, urinary tract infections, adverse effects of medications, or certain surgical procedures.

Types of urinary incontinence

Urge incontinence (also known as overactive bladder) is the most common form of urinary incontinence and is a frequent type in women. This condition may cause people to lose urine, to have the urge to go to the bathroom very frequently, to get up at night multiple times to void, or to experience bedwetting.

Stress urinary incontinence is a very common and debilitating type of incontinence. With stress incontinence, leakage occurs in spurts synchronous with activities that increase abdominal pressure, such as coughing, sneezing, laughing, lifting, and exercising. This type of incontinence is often a result of weakness or injury of the pelvic floor muscles and ligaments.

Patients who experience both stress and urge incontinence are said to have mixed urinary incontinence.

Overflow incontinence is common in men with enlargement of the prostate. Other contributing medical factors include a long history of diabetes mellitus or other conditions affecting the nerve supply to the bladder. The symptoms of overflow incontinence include incomplete emptying of the bladder and leakage.

People with functional incontinence cannot reach the toilet in time to urinate as a result of physical or mental disabilities (eg, arthritis, stroke, any condition that limits physical movement).

Evaluation and treatment

Evaluation of urinary incontinence includes a careful history and physical examination, urinalysis and urine culture, voiding diary, and urodynamic testing. Many treatment options are available for urinary incontinence, including pelvic muscle exercises, bladder training, biofeedback, and medications to relax the bladder. Minimally invasive surgery (eg, sling, laparoscopic bladder neck suspension, urethral bulking agents) can be performed as same-day surgery and has up to 95% success in treating stress urinary incontinence.

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Copyright © 2006 by WebMD. All rights reserved.

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[Guest guest]

HEY GANG, CHECK THIS OUT! HURRY!!!

eMedicine's Incontinence Feature Series delivers the latest information.

Series 1, Issue 1

Lazarou, MD

Assistant Professor of Obstetrics and Gynecology

Division Director of Urogynecology

Weiler Hospital

Albert Einstein College of Medicine

Bronx, NY

Visit our

Incontinence Center!

Ensure

delivery by adding featureseries@... to your address

book.

WHAT IS URINARY INCONTINENCE, AND CAN IT BE TREATED?

Urinary incontinence is the uncontrollable loss of urine. Men and women of all ages can experience urinary incontinence. An estimated 20-30% of people older than 60 years experience this condition, with women 3 times as likely to be affected as men. This condition may range from mild leakage to uncontrollable and embarrassing wetting. It is a major health problem because it can lead to disability and dependency. Urinary incontinence can be treated in 90-95% of all cases, and the number of treatment options is growing.

Causes

Many different underlying conditions can cause urinary incontinence. Contributing factors include pregnancy, childbirth, menopause, chronic constipation, asthma, urinary tract infections, adverse effects of medications, or certain surgical procedures.

Types of urinary incontinence

Urge incontinence (also known as overactive bladder) is the most common form of urinary incontinence and is a frequent type in women. This condition may cause people to lose urine, to have the urge to go to the bathroom very frequently, to get up at night multiple times to void, or to experience bedwetting.

Stress urinary incontinence is a very common and debilitating type of incontinence. With stress incontinence, leakage occurs in spurts synchronous with activities that increase abdominal pressure, such as coughing, sneezing, laughing, lifting, and exercising. This type of incontinence is often a result of weakness or injury of the pelvic floor muscles and ligaments.

Patients who experience both stress and urge incontinence are said to have mixed urinary incontinence.

Overflow incontinence is common in men with enlargement of the prostate. Other contributing medical factors include a long history of diabetes mellitus or other conditions affecting the nerve supply to the bladder. The symptoms of overflow incontinence include incomplete emptying of the bladder and leakage.

People with functional incontinence cannot reach the toilet in time to urinate as a result of physical or mental disabilities (eg, arthritis, stroke, any condition that limits physical movement).

Evaluation and treatment

Evaluation of urinary incontinence includes a careful history and physical examination, urinalysis and urine culture, voiding diary, and urodynamic testing. Many treatment options are available for urinary incontinence, including pelvic muscle exercises, bladder training, biofeedback, and medications to relax the bladder. Minimally invasive surgery (eg, sling, laparoscopic bladder neck suspension, urethral bulking agents) can be performed as same-day surgery and has up to 95% success in treating stress urinary incontinence.

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Privacy Policy |

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To manage your email subscription for Incontinence Feature Series, go

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[Guest guest]

For your information. I pee da bed too!

Ron

eMedicine's Incontinence Feature Series delivers the latest information.

Series 1, Issue 2

Lazarou, MD

Assistant Professor of Obstetrics and Gynecology

Division Director of Urogynecology

Weiler Hospital

Albert Einstein College of Medicine

Bronx, NY

Visit our

Incontinence Center!

Ensure

delivery by adding featureseries@... to your address

book.

UNDERSTANDING THE FORMS OF URINARY INCONTINENCE

Micturition (the urge to urinate) is a complex physiologic process involving the autonomic (involuntary) nervous system and conscious control. Although some basic physiologic details are known, the reason that a person without neurologic problems may lose urinary control remains unknown. On the other hand, incontinence resulting from anatomic defects is fairly well understood. An accurate diagnosis of the type of incontinence is important in determining the appropriate treatment. Evaluation of urinary incontinence includes a careful history and physical examination, urinalysis and urine culture, voiding diary, and urodynamic testing (tests to investigate how the body stores and releases urine).

Types of urinary incontinence

This table defines the 4 major categories of incontinence: stress, urge, overflow, and functional. Patients with symptoms of both stress and urge incontinence are said to have mixed incontinence.

Categories of Urinary Incontinence

Category

Definition

Stress

Involuntary urination with increases in intra-abdominal pressure (eg, sneezing, coughing, heavy lifting)

Urge

Involuntary urination associated with a strong desire to void; usually associated with involuntary bladder contractions (also called overactive bladder)

Overflow

Any involuntary urination associated with the bladder being too full

Functional

Involuntary urination when unable to reach the toilet in time as a result of impaired movement (not caused by defect of the urinary tract)

Causes of urinary incontinence

Significant changes occur in the lower urinary tract as a consequence of aging, many of which may cause symptoms of incontinence. These changes may be specific to gender, specific to chronic medical conditions, or common to all individuals as a consequence of the aging process. Decreases in urethral resistance and maximum bladder capacity are common in people aged 65 years or older. These changes can lead to high frequency of urination, urge incontinence, stress urinary incontinence, and urinary tract infection (UTI). These age-related changes, in conjunction with multiple other factors including previous trauma of childbirth, genetic factors, or prior hysterectomy or other gynecologic surgery, contribute to anatomical reasons for stress incontinence. Many factors that cause repetitive increases in intra-abdominal pressure, such as chronic pulmonary disease (especially in smokers), heavy lifting, constipation, and obesity, are greatly underestimated as contributors to urinary incontinence. Other conditions, such as common neurologic disorders, including Parkinson disease, cerebral vascular atherosclerosis, and multiple sclerosis, can lead to urge incontinence and overactive bladder.

In women, during the perimenopausal period, levels of estrogen decline significantly; this decline is associated with a loss of connective tissue throughout the body. This may cause decreases in bladder compliance, in the bladder’s ability to contract properly, and in urethral resistance (the ability of the urethra to contain urine within the bladder without leakage). These factors can promote urinary urgency and decrease the pressure closing the urethra, thereby predisposing a person to urinary incontinence. Urethral hypoestrogenism (low levels of estrogen) can also cause dysuria (painful or difficult urination), urgency, and frequent urination.

A severe form of stress urinary incontinence is called intrinsic sphincteric deficiency (ISD). In ISD, the urethra fails to exert sufficient resistance to hold urine in the bladder, even with only minimal or no stress. Patients with ISD commonly describe imperceptible urine loss or loss of urine during only minimal physical activity. Patients at risk of ISD are women aged 60 years or older or those who have undergone previous anti-incontinence procedures, which may have lowered nerve sensation or scarred the urethra. Such patients require further investigation with urodynamic testing. Urodynamic testing can identify patients who are not good candidates for conventional anti-incontinence surgery.

People who have a problem with urinary incontinence, or who have to get up more than twice in the night to urinate, should make an appointment with a health care provider. Many treatment options are available for urinary incontinence or other related urinary symptoms, but a proper diagnosis of the correct type of incontinence is essential for effective treatment.

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Privacy Policy |

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eMedicine Health Home: go to

http://www.eMedicineHealth.com.

Copyright © 2006 by WebMD. All rights reserved.

eMedicine.com, Inc., 8420 West Dodge Road, Suite 402, Omaha, NE 68114, .

You are subscribed as anewronald@....

To manage your email subscription for Incontinence Feature Series, go

here.