Urinary Incontinence refers to the involuntary loss of urine. This occurs more commonly in women but many men have similar problems. In both men and women, we have to evaluate for infections, overactive bladder, bladder tumors or stones or interstitial cystitis.
In women, we have to evaluate for bladder prolapse, pelvic floor weakness, commonly associated with vaginal deliveries.
In men, we also have to evaluate for prostate enlargement and obstruction, history of prostate surgery or radiation for cancer.
A variety of tests are needed to localize the cause of the problem. The routine ones would include physical exam, urinalysis, blood tests to check for diabetes and kidney function, bladder ultrasound to check for bladder residual, and cystoscopy to examine the bladder. Sometimes, urodynamic study is necessary.
Urodynamic study is a complex test done in the office with the patient awake. A tiny catheter is inserted in the bladder to measure pressure and to gradually fill the bladder. Other attachments are placed on the skin to measure muscle activity. Sometimes a tiny catheter is placed in the rectum as well to measure abdominal pressure. This studies the function and behavior of the bladder during the filling phase and the voiding phase. It can provide detailed information on how your urinary bladder functions and any associated problems.
Treatment is dependent on the type and cause of incontinence. Many times medications are sufficient. Other times surgery may be needed. One option that can frequently help with or without the use of medication or surgery is Pelvic Floor Therapy (PFT). This is a form of physical therapy for the muscles controlling urination. This is done in the office, usually at weekly intervals for 6 to10 weeks. Studies have shown improvement in as much as 70-80% of patients using pelvic floor exercises.