Incontinence Health Video

Video Transcript

DR. SUZANNE SLAYTON-MILAM: Hi. My name is Dr. Suzanne Slayton-Milam. I am with Cascadia Women's Clinic in Vancouver, Washington. Today, we are going to talk about Urinary incontinence. Urinary incontinence is defined as an involuntary loss of urine that is socially or hygienically unacceptable. The different types of incontinence that will be covered today include genuine stress urinary incontinence or DI which is called the detrusor instability, which means an unstable bladder. Mixed urinary incontinence includes both of these together, which includes most women. Your physician may have a questionnaire for urinary incontinence to obtain a more complex history from you and these may include the following questions. Do you lose your urine during coughing, sneezing or lifting? This is a sign if genuine stress urinary incontinence. Do you need to wear a pad daily? Do certain foods, drinks, give you an urge to urinate? Do you have an uncomfortable strong need to urinate to the extent that you will leak prior to reaching the toilet or while pulling down your garments? This is a sign of bladder instability. How many times do you void during the day or night? Have you wet the bed in the past year? Have lost urine with intercourse? This can be a sign of genuine stress urinary incontinence secondary to physical activity, but may also represent detrusor bladder instability secondary to irritation resulting from orgasm. When you were urinating, can you stop the flow of urine? Do you develop an urgent need to urinate when you were nervous, under stress, or in a hurry? We've all gone through these types of things, but if they are occurring more often you should be talking to your physician about them. Patients with genuine stress urinary incontinence will lose urine with activity. They do not have a need to get up at night to urinate. Very few patients have pure stress incontinence. Patients may avoid frequently and avoid drinking to avoid leakage. Detrusor instability or the overactive bladder answers yes to a lot of the questions above. They exhibit commonly a key-and-lock symptom. That is trying to get in the door of your house and having leakage of urine while you're headed to the bathroom. Mixed incontinence is an assortment of symptoms that includes the loss of urine with activity as well as this urgency, urge incontinence, and nighttime voiding. In the United States, it is becoming more common to attempt first to treat incontinence with conservative management instead of surgery. This includes pelvic floor physical therapy. Therapy teaches the patient more about voluntary control of the pelvic muscles, increasing the strength of those pelvic floor muscles, biofeedback, and bladder training. Bladder training is the process of increasing time between voids or urination by 15-minute intervals one week at a time to increase the void interval up to 3 or 4 hours. The biggest problem with behavioral therapy is the patient's dedication to learn and do pelvic floor exercises and bladder training. There are also a number of medications available on the market for assisting with bladder urgency. They can be helpful with behavioral therapy. Recommendations are usually at least three months of these medications while you go through these changes. Medication should be thoroughly discussed with your physician because of side effects such as dry mouth and constipation. These drugs should not be used in patients with glaucoma and caution with patients with heart arrhythmias. If conservative management does not suffice or moderate to extreme prolapse of genital organs has occurred, then surgery can be discussed with you physician. Some physicians will also treat prolapse and/or incontinence with the use of pessaries. These are plastic devices that are placed within the vagina to hold up the following organs. If you are menopausal, the use of estrogen should be done at the same time to prevent erosion of the pessary into the bladder or the rectum. I hope this information has improved you sense of understanding and options for urinary incontinence.