Tag Archive | "incontinence"

Hemoglobin Levels Linked to Severity of Incontinence in Older Women

Sei Lee, MD, Assistant Professor of Geriatrics at the University of California in San Francisco, and colleagues found that in older women in diabetes and urinary incontinence, very high hemoglobin A1c (HbA1C) levels are associated with patient reports of more severe limitations due to incontinence.  The data also showed, however, that in older women with diabetes, poor glycemic control does not predict the presence or absence of urinary incontinence.  The results were reported at the 71st Scientific Sessions of the American Diabetes Association.

They analyzed a large, diverse cohort of older women enrolled in the Diabetes and Aging Study, which is sponsored by the National Institutes of Health.  This five-year study examines medical care and outcomes in roughly 112,000 type 2 patients who are aged 59 years and older and enrolled in the Kaiser Permanente California Diabetes Registry.

Glycosuria has long been known to result from hyperglycemia.  Previous studies that have examined the relationship between poor glycemic control and urinary incontinence have found no association, but these studies included few patients with poor glycemic control and thus have had limited statistical power.

The outcome variables measured in this study were the presence/absence of incontinence and the severity of limitations due to incontinence.  The patients were asked “Do you experience occasional accidental urine leakage?” and “During the past 12 months, how much did the leakage of urine affect your day-to-day activities?”  The patients had the options of responding, “not at all,” “slightly,” “moderately,” “quite a bit,” or “extremely.”

The results from 3,916 older women with diabetes and urinary incontinence showed that HbA1C did not predict the presence or absence of urinary incontinence, after adjusting for age, ethnicity, education, income, parity, diabetes duration, diabetes treatment, co-morbid conditions, and body mass index.  Diabetic women with very poor control with an HbA1C greater than nine percent were about 50% more likely to be more severely limited by incontinence than women with excellent control with an HbA1C below six percent.  Dr. Lee recommended that clinicians routinely ask older female patients about incontinence.

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Sacral Neuromodulation Treats Refractory Idiopathic Urge Urinary Incontinence

According to Dutch researchers, sacral neuromodulation could be a safe, if impermanent, way to treat refractory idiopathic urge urinary incontinence.

Sacral neuromodulation, also known as sacral nerve stimulation, involves the implantation of a programmable stimulator subcutaneously which delivers low amplitude electrical stimulation through a lead to the sacral nerve, usually accessed via the S3 forament.

In a new study published in a recent issue of the Journal of Urology, Jan Groen, Ph.D., Bertil F.M. Blok, M.D., Ph.D., and J.L.H. Ruud Bosch, M.D., all from the Erasmus Medical Center in Rotterdam and University Medical Center Utrecht (JLHRB), Utrecht, The Netherlands, report on 60 women who had leads for sacral neuromodulation implanted by open surgery.

Eighty-seven percent of the women had at least a 50 percent decrease in incontinence episodes or the number of pads used daily at one month.

By five years, however, only 62 percent of the women were still reporting at least a 50 percent decrease from baseline.  Additionally, only 15 percent were completely continent.  Over half (32 patients) had 57 adverse events; most involved hardware or pain and discomfort. None were serious.

The study’s lead author Groen said that despite its decreasing effectiveness, neuromodulation “remains our first choice, especially in younger patients, as the technique is safe, does not need frequent re-treatment and is not accompanied by a possible need for self-catheterization.”

He does, however, acknowledge that the relative place of neuromodulation in the treatment algorithm and the role of its most important alternative option, botulinum toxin, are evolving.

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Post Prostate Surgery Pelvic Floor Exercises Ineffective in Improving Male Incontinence

According to a two randomized trials reported in The Lancet one-to-one pelvic floor exercise therapy for urinary incontinence after prostate surgery is no more effective than standard care.

Cathryn Glazener, PhD, from the University of Aberdeen, United Kingdom, and colleagues, reported that urinary incontinence is common immediately after prostate surgery.  As a result men are often advised to do pelvic floor exercises, but evidence to support this had been inconclusive.  The study sought to establish if formal one-to-one pelvic floor muscle training reduces incontinence.  It was supported by the National Institute of Health and Health Technology Assessment Programme.

The first trial enrolled men in the United Kingdom who had incontinence six weeks after radical prostatectomy, and the second trial enrolled men in the United Kingdom who had incontinence six weeks after transurethral resection of the prostate (TURP).  These trials compared the effect of four one-to-one therapy sessions during a three-month period to standard are and lifestyle advice only.

In trial 1, the rate of urinary incontinence at 12 months in the intervention group was not significantly different from that in the control group. Findings were similar in trial 2. These findings were unchanged by adjustment for minimization factors or by treatment-received analyses.  There were no adverse effects reported in either trial.

The authors conclude that one-to-one conservative physical therapy for men who are incontinent after prostate surgery is unlikely to be physically effective or cost effective.

Limitations of this study include incomplete blinding and lack of objective measures of incontinence.

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FDA Warns Against Procedure Used to Treat Pelvic Organ Prolapse

The US Food and Drug Administration (FDA) have announced that a mesh device used to support the pelvic organs and help ease incontinence in women seems to be riskier than previously thought.  The surgical placement of this device through the vagina to fix a condition known as pelvic organ prolapse might have increased risks as compared to other surgical methods.  The FDA has asked surgeons to consider other treatment options and to fully inform their patients of the potential complications of the surgical mesh, which is a permanent implant that may not be possible to remove.  Between 2008 and 2010, the FDA received over 1500 “adverse event” reports relating to patients who had undergone the mesh procedure.  This figure was five times as many as was reported between 2005 and 2007.  Common problems cited include pain, infection, bleeding, pain during sexual intercourse, and urinary problems.  Other problems include the protrusion or exposure of the mesh from the vaginal tissue or organ perforation during the surgical implantation of the mesh.

Pelvic organ prolapse is characterized by a weakening or stretching of internal structures that support the bladder, bowel, and uterus, causing these organs to drop below their normal position and bulge (prolapse) into the vagina.  According to the FDA, this can then lead to pelvic pain and disruption of sexual, urinary or defecatory function.

In 2010, over 100,000 mesh procedures were used for the treatment of pelvic organ prolapse, out of which 75,000 were transvaginal, in the United States.

In examining data from 1996 to 2010 comparing mesh surgeries to non-mesh surgeries, the FDA found that mesh surgeries seemed to be riskier but had no greater clinical benefit.  The FDA thus urges health care providers to remember that pelvic organ prolapse can be treated with other methods that result in fewer complications and adverse events and urges patients who have undergone the procedure to check in regularly with their doctors, especially if complications arise.  The American College of Obstetricians & Gynecologists (ACOG), who had discussed concerns about the mesh with the FDA in October 2010, has supported the FDA’s decisions.  In early September, the FDA plans to convene an independent expert panel to meet and discuss this issue.

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Drinking Less to Avoid Incontinence

A study which pulled data from more than 65,000 health and lifestyle surveys of female nurses looked at women who had not yet developed incontinence, to see whether fewer beverages each day could prevent the onset of incontinence later. The survey tracked nurses for 2-4 years, asking how much they drank each day and seeing who later developed incontinence.  The researchers tallied all beverages, including alcohol, coffee, milk, water and juice.  The survey did not ask how many beverages each day the women had, but rather the total amount of fluids they drank.

Drinking ranged from a little more than a liter – about three 12 ounce cans of soda – to nearly three liters each day. The researchers grouped the women into five categories, from the smallest amount of fluid intake to the largest.

“The rate of developing incontinence was the same” said Fran Grodstein, the lead researcher of the study. About 30 percent of the women later came to have at least one leaking episode per month which is consistent with other estimates of incontinence among women.

Incontinence can be caused by poor control over a full bladder or forced leaks from sneezing or laughing.  People who experience it frequently limit how much they drink to manage the problem and reduce leaks.

“Adequate hydration especially for older women is important and they shouldn’t be restricting fluids for fear of causing incontinence” Grodstein added.

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The Relationship between Menopause and Bladder Control

Some women have bladder control problems after they stop having periods (menopause or change of life).

After your periods end and you have been “period-free” for 12 consecutive months, your body stops making the female hormone estrogen. Some scientists believe estrogen may help keep the lining of the bladder and urethra firm and healthy. A lack of estrogen could contribute to weakness of the bladder control muscles.

In some women there is only a slight change but for others the muscles weaken to the point where holding back even small amounts of urine is very difficult. The result is urinary incontinence or quite simply, urine leaking from the body before it should.

There are two kinds of urinary incontinence – stress incontinence and urge incontinence. Pressure from coughing, sneezing or lifting can push urine through the weakened muscle. This kind of leakage is called stress incontinence. Urge incontinence means the bladder muscles squeeze at the wrong time or all the time and cause leaks.

According to the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) taking estrogen does little to counter the effects of weakened bladder muscles. There are also concerns about taking estrogen for too long and during your post-menopausal years as there are added risks from taking estrogen for many years. Taking estrogen in small does may help thicken the bladder lining and decrease the incontinence although estrogen will not repair the weak muscles or reverse the effects of declining hormonal levels. Your doctor can suggest many other possible treatments to improve bladder control.

Talk to your health care team. You may have stress or urge incontinence, but other things could also be happening. Medicines and exercises can restore bladder control in many cases. Your doctor will give you a checkup first.

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Jumpstart a Healthy Bladder Lifestyle

Simple lifestyle changes can help improve your bladder health and reduce incontinence. Here are some easy tips for a healthier bladder:


-Eat plenty of fruits, vegetables, whole  grains, lean proteins, and good-for-you-fats to keep regular and prevent constipation, which can cause bladder weakness by affecting the pelvic muscles and nerves.


-Although it may seem that drinking less fluid would be the logical solution to reduce leakage, this can actually lead to bladder or urinary tract infections (UTIs), constipation, and dehydration. All these conditions will worsen your bladder control.

-Stay hydrated! Physicians recommend drinking at least eight glasses of water per day.

- Avoid caffeinated and alcoholic beverages. Caffeine can irritate the nerves that control your bladder and cause excess urine production. Alcohol also can cause excess urine production and further relax the bladder control muscles.


-Even a few extra pounds can cause bladder control problems. Consider changing your diet and being more physically active if you are overweight. Losing weight can reduce intra-abdominal pressure, which will in turn improve your bladder control.


-Exercise is both mentally and physically beneficial. If you have been avoiding exercise or other physical activity because of leakage, try absorbent pads to help you get back on your feet.


If you have been avoiding exercise and other physical activity because the exertion causes you to leak, it’s time to stop letting your bladder limit your lifestyle. Exercise is healthy for you mentally and physically and can even help improve your bladder control.

Have sex

Sexual activity will help strengthen your pelvic muscles. In addition to intentionally practicing kegel exercises, the natural muscle contractions experienced during sex and orgasm will help improve bladder control.

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Urinary Incontinence in Men

What is urinary incontinence?

Urinary incontinence is an accidental release of urine. It is a symptom of a greater problem of the urinary tract.

Why does it happen?

-      Urine may leak out if your bladder squeezes too hard, or at the wrong time.

-      Additionally, weak or damaged muscles around the urethra can cause incontinence.

-      If your bladder doesn’t empty when it should, too much urine will remain in the bladder and possibly cause leakage.

-      Urine can build up in the bladder and leak if something is blocking the urethra.

Urinary incontinence is more prevalent in older men than in younger men, but it is not a normal part of aging.

What are the different types of urinary incontinence?

Urinary incontinence can be short-term (caused by other health problems or treatments), or long-term (chronic). The different types of chronic urinary incontinence are:

-      Stress incontinence- Occurs when you sneeze, cough, laugh, lift objects, or do something that puts stress on the bladder.

-      Urge incontinence – An urge to urinate that is too strong to make it to the toilet in time. It also occurs when your bladder squeezes when it shouldn’t.

-      Overflow incontinence – When your bladder doesn’t empty when it should, and leaks urine later. This occurs when the urethra is blocked or the bladder muscles are weak. The blockage could be due to a narrow urethra or an enlarged prostate.

-      Total incontinence – When you are always leaking urine. This occurs when the sphincter muscle no longer functions.

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Who is affected?

Incontinence (in-CONT-ti-nunce), according to the Agency for Health Care Policy and Research, affects approximately 13 million Americans – 85% of which are women. One in four women will experience episodes of involuntary urine leakage in their lifetimes, and over 50% of all nursing home patients suffer from both urinary and bowel incontinence. This common problem affects men and women of all ages, ethnicities and social backgrounds.

What is it?

Incontinence is the loss of bladder or bowl control, which means that you sometimes have difficulty urinating or controlling the urge to urinate. Incontinence is a symptom of many disorders and conditions. It can accompany pregnancy or childbirth, as well as natural changes associated with aging, pelvic surgery or injury, weak pelvic floor muscles, obesity, spinal cord injury, neurological disease, multiple sclerosis, poliomyelitis and infection. Bladder issues also occur as a side-effect of medications such as anti-depressants and alpha-blockers.

Sufferers experience both physical and emotional discomfort, and many people feel ashamed or embarrassed by their condition.

How does it work?

Your urinary system, which includes your kidneys, ureters, bladder, and urethra, is affected by incontinence. Your kidneys continuously produce urine, which is transported by tube-like ureters into the bladder. When it is convenient, the circular sphincter muscle relaxes and causes urination. If any part of the urinary system malfunctions, bladder issues can result. The two most common forms are stress incontinence and urge incontinence.

What can be done?

If you think you may have incontinence, don’t worry! The vast majority of people with bladder control issues can be helped or cured with today’s medical technology. Despite this high success rate, one in twelve suffers do not seek medical treatment. It’s important to be upfront with your doctor about your symptoms, so that he or she can formulate the best treatment plan for your specific needs.

Depending on your diagnosis, your doctor may recommend a combination of medicine and nutritional supplements, pelvic muscle strengthening exercises, behavioral modification, absorbent products and collection devices. Severe cases may require surgical treatment, but sometimes, simple changes in diet may be sufficient to cure incontinence. Talk to your healthcare professional today to see how you can begin the road to recovery.

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