Tag Archive | "stress incontinence"

Weight Loss Eases Urinary Incontinence in Heavy Women

Leslee L. Subak, MD, of the University of California, San Francisco, and colleagues, reported in a January issue of the New England Journal of Medicine that weight loss may significantly improve urinary incontinence for overweight and obese women.  A loss of about 17 pounds in an extensive six-moth diet and exercise program reduced the average number of weekly incontinence episodes by 47% compared with 28% for the control group.

Losing weight was particularly effective against stress incontinence in the randomized trial, and was as effective overall as behavioral treatments, such as pelvic muscle exercises.  Dr. Subak reports that these findings may help motivate incontinent patients to overcome the common fear of episodes occurring during exercise.  The researchers’ Program to Reduce Incontinence by Diet and Exercise (PRIDE) study included 338 overweight and obese women with at least 10 urinary incontinence episodes per week, with an average of 24 episodes per week.  Participants were randomized to an intensive six-month weight-loss program of reduced-calorie diet, exercise, and behavior modification (226 participants) or to four group classes on the benefits of exercise, a healthy diet, and weight loss (112 participants). By the end of the program, the average weight loss from baseline was 8.0, compared with 1.6% among controls.

More women in the weight-loss group had a clinically relevant reduction of at least 70% in total weekly incontinence episodes, stress-incontinence episodes per week, and urge-incontinence episodes per week.  The primary effect of weight loss was on stress incontinence, which dropped by 57.6% compared with 32.7% among controls.

Urge incontinence, which was more common in both groups at baseline, tended to also decrease with weight loss, but the effect was not significant compared with other controls.

Limitations of the study include the fact that it relied on self-reports, the lack of blinding, and the fact that participants were selected by potential for adhering to behavioral modification, which might limit generalizability.

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Urinary Incontinence is More Frequent Among White than Black Women

Elisa R. Trobridge, MD, of the University of Virginia, and colleagues have found that urinary incontinence occurs in more than twice as many white women as black women.  The reasons are not known; neither frequency of symptoms nor risk factors explained the difference.  The results were reported in the April issue of the Journal of Urology and were based on a survey of about 3,000 women.

Black women, however, with incontinence experienced significantly more urine loss.  Half of black incontinent women described their urine loss as enough to wet their underwear or pads, compared with 37.7% of white incontinent women.  Also, while black women had more urge incontinence, white women had more stress incontinence.

Previous studies derived from surveys and clinical evaluations have suggested differences between black and white women in the prevalence and type of urinary incontinence, but those studies had problems with design, population, and other factors.

This study, on the other hand, was a population-based cross-sectional one.  Dr. Trowbridge and colleagues examined racial differences in prevalence, frequency, quantity, and type of urinary incontinence in community dwelling women ages 35 to 64.  They also investigated demographic, medical history, lifestyle, and obstretric/gynecologic factors that might influence continence status.  Estimates were weighted to reflect probability and nonresponse characteristics of the sample, and to increase generalizability of the findings.

The survey was conducted by telephone and included 1,922 black women and 892 white women living in three counties in southeast Michigan.  The overall prevalence of urinary incontinence was 26.5%.  White women had a significantly higher prevalence (33.1%) than black women (14.6%).  There were no differences in incontinence frequency (about 15 episodes each month).

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Adjustable Balloon Implant Alleviates Male Incontinence

Men suffer from stress incontinence – approximately 1% after transurethral resection and up to 87% after radical prostatectomy.

The standard treatment for postoperative sphincter incompetence in men is artificial urinary sphincter but it involves complex intraoperative procedure which may be associated with significant complications.

Minimally invasive alternatives include injected bulking agents or stem cells, bone-anchored and re-adjustable bulbourethral slings, and the adjustable ProACT continence system.

The ProACT implant consists of two balloons placed on either side of the native striated sphincter. These are adjusted by inflation during follow-up visits.

French researchers report that the ProACT implant helps alleviate moderate male stress incontinence following surgery.

According to the study, 128 men who received ProACT implants were evaluated.  Of the 128 men, 40 had mild incontinence, 71 with moderate severity and 17 with severe incontinence.  Thirty patients had undergone pelvic radiotherapy.

Mean follow-up was for more than 5.5 years. The mean number of balloon adjustments was 2.33 and daily pad count decreased from a mean of 4.2 at baseline to 1.46. At the end of follow-up, 23 (18%) balloons had been removed and 17 of the explanted balloons had been reimplanted.

The functional result was a success in 68% of patients with moderate/mild incontinence. The figure for those with severe incontinence was 60%. Altogether 75% of patients believed there was improvement.

However, the objective success rate was only 46% in the patients previously treated with radiotherapy, and their incidence of urethral erosion was significantly higher.

The ProACT implant is a minimally invasive alternative that provides durable functional results in patients with mild/moderate incontinence. Potentially appropriate candidates include those with moderate leakage, no previous radiation and/ or no urethra scar.

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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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Vaginal Sling Procedure: A Good Option for Elderly Women?

Vaginal sling procedures have been shown to be effective in controlling stress incontinence in many women. But does this procedure benefit elderly patients as well? Researchers in Australia sought to answer this question in a study of 1,225 women who had undergone various types of midurethral sling surgery over the course of 8 years. The test group ranged in age from around 58 to 90, with an overall group average of 85 years old.

The success rate for the entire group was 85%, with the elderly women averaging an 81% cure and the younger group averaging 85%. Although the elderly group was more likely to fail their first attempt to urinate after surgery, the elderly women were ultimately as successful when compared to the younger group.

Regardless of age, having a BMI of over 25, mixed urinary incontinence, previous anti-incontinence surgery, diabetes, severe sphincter dysfunction and vaginal prolapsed surgery all were risk factors for possible sling failure.

The complication rate overall was similar between the two groups, although the elderly group experienced a longer average hospitalization time. Even though elderly patients tend to have a greater number of complex medical conditions, as well as more severe urinary incontinence, they appear to tolerate sling surgery well. If appropriate and desired, this minimally invasive procedure should be discussed as a possible treatment option.

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Tests You May Need for Urinary Incontinence

An accurate diagnosis of your urinary incontinence is very important because treatment based on an incorrect diagnosis may not help your incontinence and could even make it worse.

To diagnose the cause of your urinary incontinence, your doctor will do one or a combination of the following common tests and processes for urinary incontinence -

Medical history. Your doctor will ask you about your symptoms and habits, for example, how often you need to urinate, when you leak urine, how much fluid and what kinds of fluids you drink, and whether you have any other symptoms along with incontinence. Your answers will provide clues about the cause of your incontinence. Always be completely honest with your healthcare provider about your condition.

Physical exam including a pelvic exam. At this point, your doctor may also ask you to cough vigorously while you are standing or bear down as your doctor examines you and watches for loss of urine.  This is to check for stress incontinence.

Urinalysis and urine culture. A sample of your urine is sent to a laboratory, where it’s checked for signs of infection, traces of blood or other abnormalities.

Blood test. Your doctor may have a sample of your blood drawn and sent to a laboratory for analysis. Your blood is checked for various chemicals and substances related to causes of incontinence.

Your doctor may ask you to keep a bladder diary for several days (3-7 days). You record how much you drink, what you drink, how often and how much you urinate and leak and whether you had an urge to urinate.

If further information is needed, other procedures that may be done include:

Pelvic ultrasound. Ultrasound also may be used to view other parts of your urinary tract or genitals to check for abnormalities.

Bladder stress test and Bonney test. For the bladder stress test, your doctor will insert fluid into your bladder and then check for leaking after asking you to cough. The Bonney test is similar to the bladder stress test except the bladder neck is lifted slightly with a finger or instrument inserted into your vagina while the bladder stress is applied.

Pad test. A pad test can show how much urine you are passing and how often throughout the day. This is helpful when incontinence cannot be triggered during an exam.

Urodynamic testing. These tests measure pressure in your bladder when it’s at rest and when it’s filling. A doctor or nurse inserts a catheter into your urethra and bladder to fill your bladder with water. Meanwhile, a pressure monitor measures and records the pressure within your bladder. This test helps measure your bladder strength and urinary sphincter health. Urodynamic testing is expensive. It is generally done only if surgery is being considered or if treatment has not worked for you and you need to know more about the cause. It provides a more advanced way to check bladder function. Urodynamic testing may be done if other tests do not give an answer to why you have leakage of urine or your health professional suspects that you have mixed incontinence with more than one cause. The actual tests done in urodynamic testing often vary. They may include:

1.  Cystometry (cystometrography, uroflowmetry). This is a series of tests to measure bladder pressure at different levels of fullness. Cystometry tests include:

1a.  Leak point pressure (LPP), which measures weakness in the muscle that holds back urine (sphincter).

1b.  Maximum urethral closure pressure (MUCP), which measures the pressure keeping the urethra closed naturally.

2.  Postvoid residual (PVR) measurement. For the procedure, you’re asked to urinate(void) into a container that measures urine output. Then your doctor checks the amount of leftover (residual) urine in your bladder using a catheter or ultrasound. A catheter is a thin, soft tube that’s inserted into your urethra and bladder to drain any remaining urine. For an ultrasound, a wand-like device is placed over your abdomen. Using sound waves and a computer, the ultrasound creates an image of your bladder. A large amount of leftover urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles.

If the cause of incontinence is not identified by the above tests, more extensive tests may be needed.

The following tests are not routinely done to diagnose urinary incontinence.

Cystogram. In this X-ray of your bladder, a catheter is inserted into your urethra and bladder. Through the catheter, your doctor injects a fluid containing a special dye. As you urinate and expel this fluid, images show up on a series of X-rays. These images help reveal problems with your urinary tract.

Cystoscopy. A thin tube with a tiny lens (cystoscope) is inserted to look inside your urethra and the bladder. This way, your doctor can check for — and potentially remove — abnormalities in your urinary tract

Voiding cystourethrogram. This is an X-ray that uses an iodine-containing contrast liquid to show the shape of the lower urinary tract (bladder and urethra). This may make visible any physical abnormalities of the urinary tract that could be contributing to incontinence.

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