LEAKING BLADDER  -   URINARY LEAKAGE

URINARY INCONTINENCE

Urinary incontinence is loss of bladder control. It can be mild like a little urinary leakage during coughing, sneezing or exercising to episodes of loss of large amounts of urine in an uncontrollable and unpredictable fashion. This problem affects millions of women to varying degrees of severity.

Urinary incontinence is often a result of childbirth, menopause, various medical conditions or neurologic disorders.

 

TYPES OF URINARY INCONTINENCE

          Stress Incontinence                     Urge Incontinence

          Overflow Incontinence                Mixed Incontinence

                             Gross total Incontinence

 

STRESS INCONTINENCE

      Stress incontinence is one of the most common types of incontinence affecting women. It occurs when pressure ( stress) is placed on the bladder by sneezing, coughing, laughing, lifting, walking, jogging, straining, jumping up and down, bending or any activity that increases bladder and stomach pressure. It occurs often when the bladder is too full. It is caused by the weakening of the sphincter muscle the bladder has to control the outflow of urine. Childbirth often causes stretching of this muscle  and menopause is often associated with loss of strength of this bladder muscle.

Stress incontinence may occur in men who have their prostate removed.

 

OVERFLOW INCONTINENCE

    Overflow incontinence is cause by the bladder not being able to empty, thus leading to overflow leakage. Frequent dribbling, a week stream of urine when urinating,  and a feeling like you never completely empty the bladder are common symptoms. People with a damaged bladder, a blocked urethra ( prostate enlargement in men) , nerve dysfunction from diabetes, and some medications are common causes of overflow incontinence.

 

URGE INCONTINENCE    

    Urge incontinence, often called overactive bladder, occurs when your bladder muscle contracts giving you a  sudden, strong urge to urinate. Common symptoms include urinating often, waking up several times at night  to urinate , having an urge to urinate when you hear water running or after drinking a small amount of fluid. Common causes include urinary tract infections, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke or bladder injury.

 

MIXED INCONTINENCE   

    Some people have a mixture of one or more types of incontinence.  A mixture of stress incontinence  and urge incontinence is called mixed incontinence. Most women have one type that is more symptomatic than the other.

GROSS TOTAL INCONTINENCE

     Leaking urine uncontrollably and  continuously, day and night, is called gross total incontinence. Anatomical defects, spinal cord injury, and fistulas, or openings between the bladder and vagina may cause this type of serious incontinence.

 

CAUSES OF CHRONIC URINARY INCONTINENCE

PREGNANCY AND CHILDBIRTH

AGING AND MATURING

HYSTERECTOMY

INTERSTITIAL CYSTITIS  OR PAINFUL BLADDER SYNDROME

PROSTATITIS- PROSTATE INFECTION

PROSTATE ENLARGEMENT

PROSTATE CANCER

BLADDER CANCER

NEUROLOGICAL DISEA SES

URINARY OBSTRUCTION

 

PREGNANCY AND CHILDBIRTH

    Vaginal delivery can stretch and weaken the pelvic floor muscles and the ring of muscles that controls the urethra ( sphincter muscle). Childbirth can also damage bladder nerves and supportive tissue, and cause a dropped bladder producing a bulge in the vagina. Women often may complain of feeling like something in the vagina is falling out  or bulging down .  Incontinence  may develop many years after delivery or it may occur right after delivery.

 

AGING AND MATURING

          As both women and men mature the bladder muscles age also, and become weaker. This weakness leads to a decrease in the bladders capacity to store urine and an increase in overactive bladder symptoms like urge incontinence, frequent urination, inability to hold urine.

            Estrogen helps to keep the bladder muscles  and the urethra healthy and functioning well. During menopause there is less estrogen and these muscles weaken and urinary leakage frequently occurs.

 

HYSTERECTOMY

          The bladder and the uterus lie close together in a woman’s pelvis.  Total removal of the uterus may weaken the pelvic floor muscles and result in the bladder leaking.

 

PAINFUL BLADDER SYNDROME ( INTERSTITIAL CYSTITIS)

            This syndrome is caused by chronic infection of the bladder and may cause urinary incontinence, painful urination, and frequent urination. It usually affects women more often than men. 

 

PROSTATE ENLARGEMENT AND PROSTATE CANCER

          In older men, often 45 and older, a condition known as benign prostatic hypertrophy (BPH) causes enlargement of the prostate. This enlargement blocks urine from coming out of the bladder and in some men this creates a problem with overflow incontinence. Treatment for prostate cancer, such as surgery or radiation, may cause urinary incontinence as a side effect.

 

BLADDER CANCER OR BLADDER STONES

          Bloody urine or pelvic pain are common symptoms of bladder cancer or bladder stones. Urinary incontinence can also be seen.

 

NEUROLOGICAL DISORDERS

          Multiple sclerosis, Parkinson’s disease, spinal cord injury, a brain tumor or a stroke can cause dysfunction of bladder nerves and lead to urinary incontinence.

 

OBSTRUCTION

          Any type of obstruction along the urinary tract , such as from a tumor or stone, or surgical procedure may lead to overflow incontinence.

 

RISK FACTORS ASSOCIATED WITH INCONTINENCE

 

            OBESITY            SMOKING        FEMALE GENDER      AGE

          VASCULAR DISEASES      ACTIVE HIGH IMPACT SPORTS

          DIABETES    KIDNEY DISEASE

 

COMMON DIAGNOSTIC TESTS

 

BLADDER DIARY

URINE ANALYSIS

BLOOD TEST

POSTVOID RESIDUAL URINE MEASUREMENT

PELVIC ULTRASOUNDS

BLADDER STRESS TEST

URODYNAMIC TESTING

CYSTOGRAM

CYSTOSCOPY

 

TREATMENT

 

KEGEL EXERCISES ( PELVIC FLOOR MUSCLE )

BLADDER TRAINING

SCHEDULED TOILET VISITS

FLUID AND DIET MANAGEMENT

MEDICATIONS – DETROL, DITROPAN, VESICARE, ENABLEX

                   ANTIBIOTICS,  OTHER MEDICATIONS

ELECTRICAL STIMULATION

 

PESSARIES

 

BLADDER SURGERY – SLING PROCEDURE, BLADDER NECK SUSPENSION

                                                          
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                               KENNETH GOODRICH, M.D.  -  OBSTETRICIAN- GYNECOLOGIST  
     
                                           Certified by the American Board of Obstetrics and Gynecology

           Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies
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