DM Incontinence

Incontinence, or lack of bladder control, or leaking of urine is a condition affecting tens of millions of American men and women. Of this number, only a small number have sought medical help.

There are several types of incontinence that have to do with their underlying causes, but most patients fall into on of two categories. The most common is called urgency incontinence. This is usually associated with frequent urination and intense urges to void that are frequently uncontrollable, hence the leakage, and hence the term urge incontinence.

The other common type is stress incontinence. In my opinion this is not a very good term because it seems to imply that stress is the cause. This is not the case. The incontinence occurs when there is an increase in pressure in the abdomen as occurs with coughing, sneezing, lifting and exercising. One should keep in mind that these two types can occur together, and that there are other types of incontinence that are not as common and will not be part of this discussion.

The medical history tells us a lot of what we need to know. A physical exam is of course performed, and there are some specific tests of bladder function called urodynamic testing. The latter is done in an office setting and the essence of it is that a tiny tube is placed into the bladder through the urinary tract, then water is added to the bladder and pressure measurements are taken. This is not painful, and usually only takes a few minutes to obtain the information needed. With all of these facts in hand the urologist can usually determine what the problem is with considerable precision.

Treatment of course depends upon the underlying cause and the findings from any testing that may be done. In urgency incontinence the treatment is usually medical, that is, non-surgical. The two most common medications used are Ditropan XL and Detrol LA. These drugs are very safe and very effective. There are other medications and combinations that are used in some situations. In severe, unmanageable urgency, frequency syndromes there is a surgical procedure called the InterStim device which is surgically implanted into the lower back. This has brought great relief to thousands who have suffered and have not responded to medication. Keep in mind thought, that most patients do improve with medication. At Memorial City Hospital we have been very involved in this technology.

In patients with STRESS INCONTINENCE the treatment can be of several types, but is often surgical. Such techniques as biofeedback, Muscle training exercises and occasionally medications can be of benefit. In most patients surgery will be necessary. Most urologists now perform various types of “sling” procedures as these generally offer the best results. Sling procedures in my hands are usually an out patient procedure requiring only a few hours at the hospital, Recovery for most is quite rapid, with many patients returning to normal activities in just a few days.

There is a special group of individuals with stress incontinence after surgery for prostate cancer. For these men I offer two different approaches. One is what has been dubbed the “male sling” This is usually effective if the amount of leakage is not extensive. For worse cases the artificial urinary sphincter is the treatment of choice.