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Incontinence Patient Guide Table of Contents Urology Care Foundation Bladder Health Committee BLADDER CONTROLHEALTH Incontinence Patient Guide Table of Contents Urology Care Foundation Bladder Health Committee Becca’s Story . 3 CHAIR Introduction . 3 Angela M. Smith, MD, MS GET THE FACTS How Does the Urinary Tract Work? . 4 COMMITTEE MEMBERS What is Urinary Incontinence? . 4 Elizabeth Timbrook Brown, MD, MPH What Causes Urinary Incontinence? . 5 Ronald W. Glinski, MD, FACS What are the Types of Urinary Incontinence? . 5 Jairam R. Eswara, MD GET DIAGNOSED Sima P. Porten, MD, MPH, FACS GET TREATED Suzette E. Sutherland, MD, MS, FPMRS Lifestyle Changes . 6 Medical Treatments . 7 Surgical Treatments for SUI . 7 Surgical Treatment for OAB . 8 Surgical Treatments for Overflow Incontinence . 9 Products and Devices . 9 OTHER CONSIDERATIONS Preventing Future Problems . 10 Questions to Ask Your Doctor . 10 GLOSSARY . 11 2 Becca's Story Before she was treated, Becca remembers needing to use the bathroom 40 times a day, or as often as every 20 minutes . She found it impossible to take the bus to work . The 25-mile bus ride home was too long to wait . "My symptoms got so bad that I couldn't drive to work without stopping somewhere along the way," she says . When she drove into the city, she would have to add an hour or two to plan for all the needed rest stops . Becca’s primary care doctor referred her to a urologist, who diagnosed her with OAB . Tests showed Becca’s bladder was telling her brain “I have to go” all the time, rather than just when her bladder was full . Becca’s doctor told her about treatments . Although prescription drugs and lifestyle changes work for many people, they weren’t enough for Becca . After some thought, Becca chose sacral neuromodulation (SNS), sometimes called a “bladder pacemaker ”. A small stimulating device was surgically implanted into her lower back . This device stimulates the nerves to the bladder to get them to “calm down ”. Soon after her surgery, she Urinary incontinence is often a problem with bladder control was amazed to notice she could wait six hours between (as with overactive bladder, OAB ). It may be a problem with bathroom visits . Becca’s results were very positive . Becca poor urethral function (as with stress urinary incontinence, urges anyone with OAB symptoms to talk to their doctor SUI ). It can cause feelings of urgency, frequency or urine about it . As Becca knows, treating OAB can change your life leaks . For Becca, it was about her problems with OAB and for the better . leaking . Unfortunately, she has had to deal with OAB for much of her life . Introduction Millions of people in the United States live with incontinence seeking treatment, when in reality, they could have been and bladder control symptoms . It prevents men, women and feeling better all that time . children from living the life they want . The fear of being far The information in this guide can give you answers to some from a bathroom can limit choices about work and many of your questions about incontinence . We suggest you talk other things . openly with your health care provider about your symptoms . The Urology Care Foundation’s goal is to get people to There are many ways to manage and treat these problems . talk openly about their incontinence issues with their Working together, you can find relief . health care provider . Many people either do not talk about their symptoms, or assume there are no good treatments available . Because of this, many people wait years before 3 GET THE FACTS The kidneys* and bladder are part of the urinary How Does the Urinary Tract Work? tract—the organs in our bodies that make, store and pass urine . You have two kidneys that make urine . The urine is stored in the bladder . The muscles in the lower part of your Female urinary tract abdomen hold your bladder in place . When it is not full of urine, the bladder is relaxed . Nerve signals in your brain let you know when your bladder is getting full . When full, you feel the need to go to the bathroom . If your bladder is normal, you can hold urine for some time . Once you are ready, the brain sends a signal to the urethral sphincter muscle (located towards the top of the urethra) and the bladder . The urethral sphincter muscle relaxes and opens the urethra, and the bladder muscle squeezes (or contracts) forcing urine out through the urethra to empty the bladder . After going to the bathroom, the sphincter muscle closes again (or contracts) to keep urine in the bladder . It only opens again when your brain says you are ready to go to the bathroom . With urinary incontinence, some parts of this system do not work the way they should . Image © 2016 Fairman Studios, LLC What is Urinary Incontinence? Male urinary tract Urinary incontinence is a problem with bladder and sphincter control . It is the uncontrolled leaking of urine . Millions of Americans, about 1 out of 2 women and 1 out of 4 men, suffer from urinary incontinence symptoms . If the fear of leaking urine stops you from doing things you enjoy, then it is time to think about treatment . Do not be embarrassed to talk to your doctor about this medical condition . There are treatment options waiting for you! Don’t Let Urinary Incontinence Keep You from Enjoying Life. Image © 2016 Fairman Studios, LLC * All words that appear in blue italics are explained in the glossary. 4 Overactive Bladder (OAB) / Urgency Urinary What Causes Urinary Incontinence? Incontinence (UUI) Overactive Bladder (OAB) is a syndrome that often Urinary incontinence is not a disease . It is a symptom of a includes frequent urination, associated with a sudden strong wide range of health issues such as the short-term and long- urge to void . This “gotta go” feeling makes you feel that you term issues listed below . will leak if you do not use the bathroom now . If you indeed do not make it, this urge-related urine leakage is known as Short-term health issues: urgency urinary incontinence (UUI) . If you live with OAB, • Urinary tract infections (UTI) you may feel like you need to go to the bathroom many • Constipation (hard, dry stool) times during the day . You may even wake from sleep many times a night to void . It is a very common health issue for • Medicine (such as diuretics, antidepressants, many people, and it increases with aging . It is also common antihistamines, others) for people with diabetes, multiple sclerosis or stroke . For Long-term health issues: more information on OAB, visit our OAB webpage at • Diabetes UrologyHealth.org/OAB . • Stroke Overflow Urinary Incontinence • Multiple sclerosis This type of incontinence is when the bladder stays full . It • Enlarged prostate or prostate surgery for men cannot empty and so it overflows and leaks . Signs include multiple, small urinations each day, or ongoing dribbling . • Childbirth or menopause for women This is rather rare in women, but can be seen in people with diabetes, neurological disorders and/or a non-functional, underactive bladder . Most often overflow incontinence is Urine Leaks Are Not a Normal Part of Aging. seen in men who have prostate problems . Mixed Urinary Incontinence Some people have more than one type of urinary incontinence . Some people leak urine both with strong What are the Types of Urinary Incontinence physical activity (SUI) and have a strong uncontrollable sense of urgency (OAB ). This is mixed urinary incontinence . This person has both SUI and OAB . In this case, it helps to know Stress Urinary Incontinence (SUI) what is occurring and what is causing leaks to learn how to Stress Urinary Incontinence (SUI) is a common type of manage problems . urinary leakage . With SUI, the pelvic floor muscles (which hold the pelvic organs in place) have become weak, and can no longer support the bladder and urethra the way they should . Coughing, sneezing, bending, lifting, straining or even laughing, could put enough pressure on the bladder causing it to leak . 5 GET DIAGNOSED A urologist or primary care doctor will start by asking infection or other source of irritation to the bladder . A questions . They will want to know about your symptoms cough stress test may be performed to check for SUI . A and your medical history . They will ask about your health simple bladder ultrasound test to see how well you empty habits and fluid intake . They will also want to know how your bladder is often performed . Or a more involved “stress much your incontinence has changed your quality of life . test” for the bladder can be done in more complicated cases A good medical history, physical exam and a few simple (urodynamic test) to better see just how your bladder and tests are most often all that is needed to diagnose the cause urethra work . Other conditions to look for include vaginal of incontinence . A complete review of the medications hernias or pelvic organ prolapse (POP), and major bowel you are taking may reveal one that alters normal bladder problems, such as constipation or fecal incontinence . or urethral function . Your doctor may test your urine for bacteria or blood (urinalysis) to look for a urinary tract GET TREATED There are many ways to help you take control over your Bladder Training bladder . You may not need to wear pads or diapers . Some A bladder diary is the starting point for bladder training . problems are short-term and can be easily relieved . Others For 3 days, you write down what and how much you drink, take more time to treat . Treatments range from lifestyle and how often you go to the bathroom . Noting when you changes to bladder training to medications to simple leak urine can also be helpful .
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