URINARY INCONTINENCE
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.
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.
- 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.
- 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.
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.
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 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.
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