The Urology Center Glossary terms

Incontinence:

Urinary incontinence implies unwanted and unintentional leakage or loss of urine producing wet clothing, wet undergarments, wet absorbent pads or wet diapers. Millions of Americans have this problem and the total financial cost of this problem is colossal with more than 16 billion dollars spent annually in the U.S.. Unfortunately, most of this expenditure goes for pads and diapers and only a small portion of these dollars are used for treatments which have been shown to alleviate the problem. This socially stigmatizing problem is treatable in all cases and curable in most!

This socially stigmatizing problem is treatable in all cases and curable in most!

Millions of people silently endure continuously wet undergarments or pads. A rash may develop; the adult equivalent of diaper rash. Affected patients are often concerned about the continuous odor of leaking urine which makes them uneasy near other people that might detect the odor. Incontinence is associated with urinary tract infections, falls, fractures, embarrassment, stigmatization, depression and risk of institutionalization (nursing home placement). Some patients even become reclusive, refusing to go out in public for fear of wetting themselves when no bathroom is nearby. Otherwise healthy patients who become incontinent may find that they are no longer socially, physically or even sexually active and some become progressively more isolated.

Many people are under the mistaken impression that no treatment is available.

While the problem is more common in women, it is not rare in men, especially with neurological conditions and after prostate cancer surgery. Approximately 45 percent of women develop incontinence of urine, however, less than one woman in 25 will seek medical advice. Many people are under the mistaken impression that no treatment is available. Others seek the advice of doctors, only to be shrugged-off, dismissed or given ineffective medications. Some women have undergone attempted surgical correction of the problem years earlier, yet the problem may have returned only a short time after the older outmoded surgery.

A thorough evaluation by a qualified urologist allows separation of incontinence problems into several broad categories -- each treated differently. Incontinence may be divided into several broad general categories: anatomical stress urinary incontinence (SUI), urge urinary incontinence (UUI), intrinsic sphincter deficiency (ISD) and overflow incontinence.

However, less common forms of urinary incontinence should not be overlooked. One of these less common forms of incontinence involves the development of an abnormal connection between the urinary tract and other organs, known as a fistula. This is a complicated and very special problem which may be very difficult to detect and treat. Detection of a urinary fistula requires detailed x-rays and testing followed by surgical correction.

A somewhat more common cause of urinary incontinence is neurological disease. The type of urinary incontinence thus produced is known as neurogenic bladder dysfunction. Neurological causes of urinary incontinence include herniated disk disease, multiple sclerosis, stroke, Parkinson's disease and spinal cord or brain tumors.

Sometimes urinary incontinence is the first symptom of a serious medical problem [such as, herniated disk disease, multiple sclerosis, stroke, Parkinson's disease and spinal cord or brain tumors].

Sometimes urinary incontinence is the first symptom of a serious medical problem. Careful urological examination is also needed to exclude the possibility of these and even more serious medical problems which effect not only the bladder but the body as a whole. A urologist specializing in urinary incontinence evaluation and treatment is the most qualified medical professional for the accurate characterization and treatment of all forms of urinary incontinence.

Today, most cases of isolated stress urinary incontinence are completely reversible.

Of the more straightforward forms of incontinence, anatomical stress urinary incontinence (SUI) is perhaps the most common type of incontinence in women. In women, SUI results from weakness of the muscles and supportive ligaments of the pelvic floor. The muscle weakness allows the bladder and other pelvic organs to push down on the walls of the vagina creating prolapse of these organs into the vagina. Many patients refer to this as a "fallen bladder". The urine leakage occurs primarily with straining, coughing, sneezing, walking, standing up or most any activity that increases the pressure on the organs within the abdomen and pelvis. Today, most cases of isolated stress urinary incontinence are completely reversible.

Intrinsic sphincter deficiency (ISD) produces urine leakage similar to stress incontinence. In fact, ISD is considered to be a variant of stress incontinence. It is more commonly found in women who have undergone prior pelvic surgery, in older women who have a deficiency of estrogen and in men who have undergone prostate cancer surgery. The urine leakage occurs under the same circumstances as stress incontinence, but ISD is not generally associated with any prolapse or movement of the bladder or pelvic organs. That is, ISD is not usually associated with weakness of the muscles and supportive ligaments of the pelvic floor. Rather, it is caused by fibrosis, drying or scarring of the urethra, due to one of the conditions discussed above.

... intrinsic sphincter deficiency (ISD) is associated with accidental wetting with even the slightest provocative cough or movement.

Unlike stress incontinence, intrinsic sphincter deficiency (ISD) is associated with accidental wetting with even the slightest provocative cough or movement. In women, estrogen supplementation and a simple office procedure known as collagen injection often effectively control this form of incontinence. However, repeated collagen injections are necessary to maintain dryness, otherwise, formal surgical repair is generally needed. Men with ISD often may try collagen injection therapy but this treatment is commonly ineffective. Men with severe ISD require implantation of an artificial urinary sphincter (AUS) or placement of a pubourethral sling.

Urge type urinary incontinence (UUI) is very common in both sexes ...

Urge type urinary incontinence (UUI) is very common in both sexes, resulting from bladder contractions which occur unpredictably. The unpredictable bladder contractions result in the involuntary sudden loss of urine associated with the sudden strong desire to urinate. A slight urge is often noticed after which a strong uncontrollable urge to urinate occurs, commonly on the way to the bathroom. In women this urgent need to urinate may also occur with stress incontinence. That is, UUI and stress incontinence commonly occur together in women. While most cases of UUI are rather benign, sudden bladder contractions are commonly the first sign of neurogenic bladder disease, a serious medical condition described above. For this reason and others, a urologist specializing in urinary incontinence evaluation and treatment is needed for the accurate characterization and treatment of urge type urinary incontinence.

In men UUI is commonly associated with prostate enlargement and slowing of the urine stream.

In men UUI is commonly associated with prostate enlargement and slowing of the urine stream. This association of UUI with prostate problems in men makes treatment very challenging and potentially complicated. In these cases some men may become completely unable to urinate after receiving medications such as Ditropan or Detrol which otherwise would be standard treatment. In these case, a very thorough urology evaluation must be performed before medications are prescribed. The good news is that except in complicated circumstances, most cases of urge urinary incontinence may be completely controlled using medications, exercises and behavioral techniques.

... incontinence certainly is not an inevitable part of life. That is, unwanted urinary leakage is not at all a natural part of aging!

In many cases incontinence becomes more prominent and more severe with aging. However, incontinence certainly is not an inevitable part of life. That is, unwanted urinary leakage is not at all a natural part of aging! Besides, most would agree that any age is "too young" to have such an annoying and frustrating problem, especially when effective treatment is so readily available.

Noninvasive or minimally invasive treatments such as collagen injection and sling procedures are now routinely available and new FDA approved medications have proven safe and effective. Artificial urinary sphincter surgery is the time tested mainstay treatment for severe male urinary incontinence. However, new male sling surgery has proven safe and effective. Treatment success rates are now higher than ever.

There is no reason that anyone should have to live with pads, diapers, odor and wetness.

Now more than ever, women and men with urinary incontinence have more options available. There is no reason that anyone should have to live with pads, diapers, odor and wetness. A urologist specializing in urinary incontinence evaluation and treatment is the most qualified medical professional for the accurate characterization and treatment of all forms of urinary incontinence. Effective treatment is readily available at the Urology Center and we welcome your questions.

(Please visit our Female Urology Center of Excellence for additional information.)