URINARY INCONTINENCE 2017-08-17T11:27:42+00:00

URINARY INCONTINENCE

DEFINITION:

Urinary incontinence is the leakage of urine that happens beyond one’s control. The severity ranges from occasionally leaking urine with a cough or sneeze to having an urge to urinate that’s so sudden and intense that the urine just starts running out.

TYPES OF UI

Female urinary incontinence can be grouped in several distinct categories, although women often have symptoms found in more than one category (i.e., mixed incontinence).

Urine leakage that occurs with increase in intra-abdominal pressure such as with coughing, sneezing or straining.

Leakage of urine due to an intense urgency that cannot be suppressed. Also referred to as overactive bladder or got-to-go problem.

Combination of stress and urge incontinence

Leakage of urine due to a very large bladder volume that acts as a full tank that forces open the urethra. This generally happens when there is some blockage or obstruction to the bladder’s ability to empty. This kind of leakage is less common among women, unless they have had recent bladder or pelvic surgery. It could also happen with some medical conditions such as longstanding diabetes, nerve injuries, spinal cord injuries, multiple sclerosis, or with active herpes infections. It is usually seen as constant dripping of urine in the absence of urgency or straining.

Urine leakage that happens due to difficulty in making it to the bathroom due to physical limitations such as arthritis or stroke. This may or may not represent a problem of the pelvic floor, but should certainly be addressed with a health-care provider. Simple remedies for this condition may include bedside commode.

This happens when there is a direct communication between the bladder and the vagina. This could happen after a complex gynecologic surgery, delivery, trauma or pelvic radiation.

UI PREVENTION

Incontinence is not always preventable. However, you may be able to decrease the risk of urinary incontinence with these simple steps:

  • Maintain a healthy weight. By taking good care of yourself and keeping or getting your weight under control, you may be able to decrease your risk of urinary incontinence.
  • Don’t smoke. Get help in quitting if you do smoke. Smoking weakens the tissues and also predisposes to a chronic cough which further puts pressure and strain on the pelvic floor.
  • Practice kegel exercises. This should be started right after delivery and one should continue doing these frequently.
  • Avoid bladder irritants. Avoiding or limiting certain foods and drinks such as coffee may help prevent or limit urinary incontinence.
  • Eat more fiber. Including more fiber in your diet or taking fiber supplements can help prevent constipation, a risk factor for urinary incontinence.
  • Be active. Physical activity reduces your risk of developing incontinence.

COMPLICATIONS FROM UI

Incontinence is not life-threatening but can result in certain undesirable physical, mental and psychological limitations.

  • Skin problems. Constant wetness because of urinary incontinence can result in vulvar irritation, sores and vulvar rash. On a long-standing basis, it could also lead to breakdown in the vulvar skin and predispose to superimposed bacterial infection
  • Changes in physical and social activities. Urinary incontinence may keep you from participating in normal activities. You may stop exercising, quit attending social gatherings or even refrain from laughing due to fear of an accident. You may even reach the point at which you stop traveling or venturing out of familiar areas where you know the locations of toilets. Unfortunately, the pad becomes your best friend.
  • Changes in your work life. Urinary incontinence may negatively affect your work life. The urgency and frequency will result in distraction from normal day-to-day activities and lack of concentration at meetings. It becomes harder and harder to attend long meetings or conferences. Nocturia or nighttime frequency may keep you up at night and therefore make you drowsy in the daytime and further worsen the already diminished concentration ability. All in all urinary incontinence may wreak havoc in your work life.
  • Changes in your personal life. Perhaps most distressing is the impact incontinence can have on your personal life. Your family may not understand your behavior or may grow frustrated at your many trips to the toilet, the too many stops during long distance drives etc. Fear of incontinence during intercourse may also lead you away from your significant other and could create marital disharmony. It’s not uncommon to experience anxiety and depression along with incontinence.

UI TESTING

VOIDING DIARIES – BLADDER LOG

This is a very helpful tool to keep track of your bladder’s behavior. Many urinary issues develop slowly, over time. Many women aren’t even aware of how often they are voiding, or how often they make changes to their activities because of fear of leakage. This is mainly because the problem of incontinence has been sneaking up on them for so long. Seeing these things “in writing” can be quite instructive and is also very useful for us to determine the correct treatment. At the beginning of treatment, these diaries are helpful in establishing the nature and severity of the problem. As the treatment progresses, we can monitor improvement by having you repeat these diaries and comparing them to the ones from before.

There are two diaries. One is a 24 hour diary and the other is a 3-day diary. The 24 hour diary is a detail analysis and it includes not only the amount of urine produced but also the amount of fluids taken in over a 24 hour period.

VOIDING DIARY LOGS

3 Day Diary

24 Hour Diary

This test has to be done at home as you will have to use the measuring hat under your toilet seat for this. This may not always be possible to do so at work unless you have your own private bathroom. It is very important that you measure exactly the amount of urine and the time of day when you go to urinate.

There is no need to collect and store the urine. As soon as you finish urinating, measure the amount of urine in the hat and dispose it. Restart this again when you go to the bathroom. Every time you go to the bathroom make a note of the time when you went and the amount of urine voided.
Also, if there are any incontinence episodes that might happen then please make a note of the time when it occurs and also if these were associated with any urinary urgency. There is also a section to mark and describe what was happening at the time when the incontinence episode happened. This could therefore be written as “I leaked when I was coughing or sneezing” or “I had to run to the bathroom and was not able to make it” etc… You should also grade the severity of the incontinence based upon the scale provided on the sheet.

Equally important is the rightmost column which describes the amount of fluid intake. It is a very critical that you mark exactly the amount of fluid that you drink per that 24 hour period. Therefore to be compliant, the best is to drink from a standard cup such as a 12-oz cup. You can note the amount of fluid intake in ounces or ml. It is equally important to state the type of fluid intake. If it is soda, you should state whether this was caffeinated or decaffeinated coke. If it is coffee state the same.

Do not change any of these amounts or type of fluids just because you are doing the diaries. We actually want to see what typically has been going on over the past few months in your day to day life. The voiding diaries will help us determine this.

It is very important that you keep these diaries as it will impact your management. If you are serious about regaining control of your bladder then this is the least that you should be doing to help yourself. It is an eye opener for many patients as they now realize how often they are actually going to the bathroom. More importantly it sets up a correlation between fluid intake and urine production.
Preferably so that we can review them and the Urodynamicist can then correlate the findings with your diaries. The diaries, however, have to be absolutely done before you return for the consultation visit with me. I shall review the diaries with you at that time.
Absolutely not. We would like to see the raw data, as is. So changing things for the test would not show me the correct picture and hence my treatment plan may be affected.
We understand that it is hard to turn on all the lights, pull on the reading glasses and take notes. Sometimes, it is easy to remember the amounts and especially the number of times you went and note it the first thing when you wake up.

Performing the exercise of the 24-hour and 3-day diaries is not just to help us with the diagnosis but it also puts into perspective the true impact of incontinence on your life. We would like all our patients to keep the diaries, if feasible. However, for whatever reason you are unable to, then it may have an initial impact on the management but over time we should be able to come up with the correct plan.

So in other words, if you are able to then you should absolutely do the diaries.

URODYNAMICS 

Urodynamics is a method of testing the function and behavior of the bladder and the urethra (the tube that leads from your bladder to the outside) in real time. The test involves the placement of a small pressure transducer into the bladder and another in the vagina. Sterile fluid is then instilled into the bladder at a set rate and changes are noted on a graphic recording with emphasis on clinical correlation.

Urodynamics is a very important test as it helps us come up with a correct diagnosis especially when the history and physical examination is inconclusive.  The reasons that a woman might be experiencing incontinence, urgency, or difficulty emptying her bladder can be very complex, and Urodynamics help us figure out what might be going on, and the best treatment to institute.

The testing should not be painful as the transducers are much smaller than a catheter. As your bladder is filled with sterile fluid, you may feel as though you have the urge to urinate. These sensations are an important part of the test itself, so be sure to tell the staff what you are feeling. You may be asked to cough, bear down, or do other maneuvers which might make you leak urine. It is important to remember that Urodynamics will help us find the right treatment to fix your condition.

Some people have mild burning or irritation when they urinate after the test; this should go away within a day. You should be able to resume your normal activities after testing.

Please arrive at the office with a full bladder if you can, as this helps us assess your voiding (urinating) pattern without the transducers. We may also collect urine for analysis and also check the postvoid residual (i.e. the urine left behind in the bladder after peeing). If you have a history of Mitral Valve Prolapse or need antibiotics before a procedure (such as with metal prosthesis for the knees etc.), please let us know ahead of schedule so that we can call in the antibiotics.
NO. You can return back to your normal and full activities. There are absolutely no restrictions.
You may have some irritation during urination but this will be transient. You may be given Pyridium to take after the test. Take it if you have any residual burning. If the bladder symptoms persist after 24 hours, then please call us. You may rarely get a urinary tract infection following the urodynamics but this can be readily treated.

As soon as the test is completed, the Urodynamicist will go over the basic findings and make sure that you have the correct AUGM book to review. You will be asked to make a follow up appointment to discuss the treatment plan.

CYSTOSCOPY

Cystoscopy is a technique that uses a telescope and light to look inside your bladder.
Cystoscopy is performed in the office entirely under local anesthesia. Local anesthesia gel is applied to the urethra to numb it. The urethra is the tube that brings the urine out from the bladder to the outside. It is a short and straight tube and therefore very easy to enter. Once the gel is applied, a tiny telescope is passed into the bladder. Sterile fluid is then used to fill the bladder, so that we can see inside. This allows us to make sure that there are no abnormalities or other problems which might be causing your bladder symptoms. The test generally takes 10 minutes.
Cystoscopy helps us rule out any pathologic causes of your bladder symptoms.  It is usually  performed in patients who have irritative bladder symptoms such as urgency and frequency or those with frequent bladder infection, blood in the urine or vaginal prolapse ( bulge of the bladder) with incomplete bladder emptying. It can help pick up causes such as stones, infection or rarely cancer that might be causing the bladder dysfunction.
CYSTOSCOPY IS NOT PAINFUL. Most patients feel nothing at all. There may be a transient discomfort that lasts just a few seconds as the telescope goes into the bladder. Remember the numbing medicine takes care of the discomfort. As your bladder is filling with water, you may feel the need to urinate. Some people have mild burning or irritation with urination after the test; this should go away within a day. You should be able to resume your normal activities after cystoscopy. There are no restrictions after the procedure.
It is very IMPORTANT that you drink fluids before you come to the test. You DO NOT have to hold urine or come with a full bladder. If you drink enough fluids, we shall be able to see the urine excretion from the ureters on the inside faster and this shortens the test time. If you have a history of Mitral Valve Prolapse or need antibiotics before a procedure (such as with metal prosthesis for the knees etc.), please let us know ahead of schedule so that we can call in the antibiotics. Otherwise, you do not need any other preparations. Even if you are on a blood thinner, there is no need to stop it for this procedure as there is no cutting or surgery involved.
NO. You can return back to your normal and full activities. There are absolutely no restrictions.
You may have some irritation during urination that may last from a few minutes to an hour. You may also have slight burning and may see some blood when you urinate. If these symptoms persist or if the burning symptoms worsen, then please call us. You may rarely get a urinary tract infection following the cystoscopy and this can be easily treated.