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There are three types of incontinence that affect millions of people, both women and men, annually. While it is age associated, it does not have to be inevitable consequence of aging. When it affects your daily activities, independence, ability to travel, it’s time to discuss it with your care provider.
The most common is urge incontinence (UUI) which is characterized by sudden urges to urinate, often in situations where there was no indication of a need to void. Initially, this bladder problem may start as frequent, urgent urination but as it progresses, it leads to urge incontinence, leakage without warning and pad use. The initial treatment is timed voiding i.e. “beating your bladder to the punch” which means urinating by the clock every two hours while you are awake. There are certain food and beverages that can exacerbate the symptoms including the classics i.e. caffeinated or carbonated beverages but others that may surprise you i.e. grapes, onions, spicy foods. As symptoms worsen, daily medications may be needed to help control the urges and provide the patient time to make it to the restroom in time without leaking. If medications don’t suffice in controlling symptoms, intra vesicle Botox injections (an office-based procedure), a pacemaker (Interstim) implant, or even posterior tibial nerve stimulation maybe be the next steps in treatment.
Stress urinary incontinence (SUI) typically affects more women than men and is characterized by sudden leakage of urine during a “stress” type maneuver i.e. coughing, sneezing, lifting, exercise, standing. It is associated with age, child birth and pregnancy as well as certain prostate surgeries. The initial treatment may involve physical therapy, weight loss, timed voiding and then as symptoms progress and patients start avoiding activities they otherwise enjoy, surgical repair may be needed. One such surgery is a urethral sling (not to be confused with a bladder sling) that is positioned under a patient’s urethra and provides support during “stress” maneuvers. Slings are outpatient procedures that are incredibly successful and last for many years. Typically, there is little pain after the 45-minute procedure and other than no lifting over 20 lbs. for three weeks, women are back to essentially normal activities in just a few days. Injection therapy is also employed to alleviated SUI in certain instances where the lack of sphincteric contraction is the cause of incontinence. This is typically the case in older women and will be determined based on symptoms and pre-operative office-based evaluation.
The third type of incontinence is overflow urinary incontinence and typically affects more men than women. This is usually related to incomplete bladder emptying due to prostatic enlargement. Other less common causes can be previous pelvic surgery, certain neurologic injuries/diseases, bowel issues, medications and even behavioral. The etiology of the incontinence drives therapy and may include surgery or even self-intermittent catheterization.
Please do not be hesitant to discuss this extremely bothersome symptom with your health care provider. There are often simple suggestions that can make a big impact!
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