Urinary incontinence affects millions of women of all ages. One in three women experience bladder leakage during some point in their lifetime. Understandably, one’s quality of life diminishes in proportion to the severity of incontinence. Not only can it be socially embarrassing, but it can result in social isolation, avoidance of physical activities, and additional costs (loss of work, pads, laundry, etc). Medical problems such as spinal cord injury, multiple sclerosis, and Parkinson’s disease may trigger or worsen incontinence. Certain medications such as diuretics may also impact bladder control. It is equally important to understand the severity and impact on a patient’s daily activities and the patient’s goals.
The evaluation process begins with a thorough examination and examination of the urine specimen. The urinalysis is useful to check for a urinary tract infection or the presence of blood, which would require further evaluation. The next step is to categorize the type of incontinence. There are four categories of incontinence:
Conservative treatment may begin with bladder and pelvic floor retraining exercises (Kegels), fluid management, and avoidance of dietary irritants.
Caffeinated, alcoholic, and carbonated beverages can worsen bladder control. We work closely with a number of excellent physical therapists who provide additional support to help patients learn mechanisms to improve bladder and fecal incontinence. Besides Kegels exercises, placement of a tampon or use of a pessary with a knob may offer relief from stress urinary incontinence.
When a patient is not satisfied with the results of conservative measures, further evaluation of her incontinence needs to take place. A bladder diary is typically elicited that is a record of fluid intake (quantity as well as type of fluid), number of voids (and possibly measured volume of each void), number of pads/diapers used, and number of incontinent episodes. Additional testing may be necessary that would include urodynamics and/or cystoscopy. These tests are very commonly used for further evaluation. They are performed in the office setting and no preparation is needed.
Urodynamics testing is composed of several components that measure how well the bladder and sphincter muscles function. Essentially, the test measures how much your bladder holds, how well it stores fluid, and how well the bladder empties.
It also gives information on the urinary flow (speed, pattern, and voiding time). The EMG component tests the electrical activity of the nerves and muscles of the pelvic floor. The urodynamics study can be thought of as the “EKG for the bladder". Cystoscopy looks at anatomy. Through a small telescope with magnified lenses, the urethral and bladder lining are visualized. This is typically a simple 5 minute evaluation that allows evaluation of the bladder muscle and urethra. Bladder muscle thickening, diverticula, strictures, polyps, inflammation, stones, and tumors can be identified through visualization. Local anesthetic may be administered for this test.
It is a sudden, intense, urge to urinate that is difficult to postpone and results in an involuntary loss of urine. Simply stated, it is when the bladder contracts (spasms) without your permission and you cannot prevent urinary leakage.
Dr. DuPont was the first to offer intravesical Botox for the treatment of overactive bladder and urgency incontinence in the Washington DC area.
Dr. DuPont typically describes this to patients as “the cup runneth over.” The bladder is not emptying properly, it over fills, and urine leaks or dribbles out. Typically, it results in a weak urine stream, dribbling, and a feeling of fullness. Urinary tract infections may also result when the bladder does not empty. Overflow incontinence occurs secondary to the bladder muscle not contracting properly or a blockage of the lower urinary tract.
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