Urge Incontinence

• Loss of urine that is associated with a sudden, strong desire to urinate, which cannot be postponed.
• Sudden loss of urine in a rush to reach the bathroom.
• Occur in association with certain triggering events, such as sound of running water, exposure to cold
• Need to urinate more frequently during the day and waking often during the night to urinate
• Also called overactive bladder
• Also affect men
• Overactive bladder is not normal at any age
• There are at least 20 million Americans who suffer from symptoms of overactive bladder, yet only one fourth seeks help.

Impact of overactive bladder on quality of life

• Limitation or cessation of physical activity
• Absence from work
• Decreased productivity
• Require specialized underwear and bedding
• Special precautions with clothing
• Reduction in social interaction
• Limit and plan travel around toilet accessibility
• Guilt, depression, loss of self-esteem
• Fear of urine odor

What causes overactive bladder

• Most common in elderly
• Urinary Tract Infections
• Multiple pregnancies
• Obesity
• Diabetes
• Stroke
• Multiple Sclerosis
• Alzheimer’s disease
• Parkinson’s disease
• Interstitial cystitis
• Pelvic organ prolapse
• Anxiety

Most common in elderly

• Urinary Tract Infections
• Multiple pregnancies
• Obesity
• Diabetes
• Stroke
• Multiple Sclerosis
• Alzheimer’s disease
• Parkinson’s disease
• Interstitial cystitis
• Pelvic organ prolapse
• Anxiety

Symptoms

• Inability to hold back your urine flow
• Rushing to the bathroom
• Frequently voiding during the day and night
• Loss of urine while sleeping

Diagnosis

• Urinalysis, urine culture
• Bladder diary
• Post void residual urine
• Cystoscopy
• Urodynamic evaluation

Treatment

Non invasive treatment

• Simple life style or behavioral modifications are often the first treatment
• Avoid constipation
• Limiting alcohol and caffeine consumption
• Quit smoking
• Exercise regularly
• Spacing drinks though out the day
• Drink at least 1 quart of water per day, increase gradually to1 quarts
• Avoid carbonated beverages
• Avoid chocolate, tomatoes, acidic fluids (cranberry, orange, grapefruit, lemon, apple)
• Kegel exercise
• Biofeedback
• Pelvic floor electrical stimulation

Medical therapy

• Estrogens either oral or vaginal – increases the muscle tone
• Anticholinergic drugs – they inhibit involuntary bladder contractions, reduce urinary frequency and incontinence episodes. Those drugs are Ditropan (oxbutynin), Ditropan XL, Detrol LA, Vesicare, Enablex, Oxytrol, Sanctura XR, Levsin, Banthine, Pro-Banthine

Side effects of anticholinergic drugs are

• Dry mouth
• Constipation
• Headache
• Nausea

Contraindications – closed angle glaucoma. All anticholinergic drugs are effective for treatment of overactive bladder symptoms.

Tricyclic antidepressants

• They facilitate urine storage, decrease bladder contractions and increase outlet resistance. They are Tofranil, Elavil

Alpha adrenergic drugs

Increase outlet resistance. That drug is Sudafed

Percutaneous Tibial Nerve Stimulation

Non invasive office procedure

Surgery

• Sacral nerve stimulation “Interstim” - Interstim is an implantable neuromodulation system that sends mild electrical pulses to sacral nerve. Sacral nerve stimulation may relieve the symptoms of overactive bladder.
• Augmentation cystoplasty - In extreme cases, bladder may be made larger by adding a portion of intestine to the bladder.
• Botox - Botox blocks the release of chemicals which cause bladder muscles to contract involuntarily, thus improving the symptoms of overactive bladder. Botox has not been yet approved by FDA for injection in the bladder, so it is usually not covered by insurance.
• Injection therapy - Injections of bulking agents into the tissue around the urethra may add bulk and may keep the sphincter muscle closed and stop urine from leaking. Injectable materials includes – collagen and Durasphere. The procedure is done as an outpatient with sedation anesthesia. A needle is inserted through the urethra  and the bulking agent is injection into the area around the bladder neck.
• Collagen – A natural animal substance – but it breaks down after several months – so injections have to be repeated.
• Durasphere – Durasphere is a water based gel that contains tiny, carbon coated beads. This material is not absorbed providing long lasting results.