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Suggest treatment for urinary incontinence

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General & Family Physician
Practicing since : 2012
Answered : 3614 Questions
Question
I am incontinent and hate it. It makes it almost impossible to travel, even to the grocery store. Sometimes I don`t know that it is happening. I`m 63yrs young and recently divorced and with this problem; I won`t consider dating. Actually, I am chained to the commode. It isn`t a little leak but total bladder opens up like Niagra Fall. I weighed 399lbs 1 1/2 yrs ago. Since then I have lost152 lbs. and the doctors say that it due to the weight loss. I have Type 2 diabetes (under control), sleep apnea (cpap & O2), depressed and on and on.
I have seen several specialists and unsuccessfully complied with their ideas. Another doctor said; "Live with it, you had too many children, overweight, old, medication...."
I am on desmopressin and oxybutynin and it has not worked.
One doctor (internal medicine), had me use a folie for years; which lead to multiple UTI`s.
Please tell me there is hope. I need a treatment that is effective.

Posted Mon, 25 Aug 2014 in Medicines and Side Effects
 
 
Answered by Dr. Shafi Ullah Khan 4 hours later
Brief Answer:
There is always hope. Needs management

Detailed Answer:
Thank you for asking
You Are Not Alone In This. Upto 84% people at your age gets affected from this trouble. In order to treat it we need to know what type it is and to know that a little lab work is needed as management is tailored to the type of incontinence. Whether it is stress , urge , mixed or functional will decide how to manage it.and yo do that basic evaluation is needed focussing on


Voiding diary
Cotton swab test
Cough stress test
Measurement of postvoid residual (PVR) urine volume
Cystoscopy
Urodynamic studies
The following points regarding the clinical presentation should be sought when obtaining the history:
Severity and quantity of urine lost and frequency of incontinence episodes
Duration of the complaint and whether problems have been worsening
Triggering factors or events (eg, cough, sneeze, lifting, bending, feeling of urgency, sound of running water, sexual activity/orgasm)
Constant versus intermittent urine loss
Associated frequency, urgency, dysuria, pain with a full bladder
History of urinary tract infections (UTIs)
Concomitant fecal incontinence or pelvic organ prolapse
Coexistent complicating or exacerbating medical problems
Obstetrical history, including difficult deliveries, grand multiparity, forceps use, obstetrical lacerations, and large babies
History of pelvic surgery, especially prior incontinence procedures, hysterectomy, or pelvic floor reconstructive procedures
Other urologic procedures
Spinal and central nervous system surgery
Lifestyle issues, such as smoking, alcohol or caffeine abuse, and occupational and recreational factors causing severe or repetitive increases in intra-abdominal pressure
Medications
Relevant complicating or exacerbating medical problems may include the following:
Chronic cough
Chronic obstructive pulmonary disease (COPD)
Congestive heart failure
Diabetes mellitus
Obesity
Connective tissue disorders
Postmenopausal hypoestrogenism
CNS or spinal cord disorders
Chronic UTIs
Urinary tract stones
Benign prostatic hyperplasia
Cancer of pelvic organs
Medications that may be associated with urinary incontinence include the following:
Cholinergic or anticholinergic drugs
Alpha-blockers
Over-the-counter allergy medications
Estrogen replacement
Beta-mimetics
Sedatives
Muscle relaxants
Diuretics
Angiotensin-converting enzyme (ACE) inhibitorsh

After that management will be tailored according to that.



Successful treatment of urinary incontinence must be tailored to the specific type of incontinence and its cause. The usual approaches are as follows:
Stress incontinence: Pelvic floor physiotherapy, anti-incontinence devices, and surgery
Urge incontinence: Changes in diet, behavioral modification, pelvic-floor exercises, and/or medications and new forms of surgical intervention
Mixed incontinence: Pelvic floor physical therapy, anticholinergic drugs, and surgery
Overflow incontinence: Catheterization regimen or diversion
Functional incontinence: Treatment of the underlying cause
Absorbent products may be used temporarily until a definitive treatment has a chance to work, in patients awaiting surgery, or long-term under the following circumstances:
Persistent incontinence despite all appropriate treatments
Inability to participate in behavioral programs, due to illness or disability
Presence of an incontinence disorder that cannot be helped by medications
Presence of an incontinence disorder that cannot be corrected by surgery
In stress and urge urinary incontinence, the following medications may provide some benefit:
Alpha-adrenergic agonists
Anticholinergic agents
Antispasmodic drugs
Tricyclic antidepressants
Estrogen
Alpha-adrenergic blockers
Botulinum toxin
Surgical care for stress incontinence involves procedures that increase urethral outlet resistance, including the following:
Bladder neck suspension
Periurethral bulking therapy
Midurethral slings
Artificial urinary sphincter
The transobturator male sling may be of particular benefit to men who experience stress incontinence after prostatectomy.Transobturator vaginal tape (TVT-O) is widely used for stress incontinence in women. In an Italian study of 181 consecutive cases of TVT-O surgery, Serati et al found no significant difference between older women (70 years or older) and younger women in terms of cure rate, voiding dysfunction, vaginal erosion, persistent groin pain, or onset of de novo overactive bladder. The cure rate for the older group was 88.3% and for the younger group was 92.5%
Surgical care for urge incontinence involves procedures that improve bladder compliance or bladder capacity, including the following:
Sacral nerve modulation
Injection of neurotoxins such as botulinum toxin
Bladder augmentation
Seek a urologist and let them decide what is best for you. There is always a hope.
I hope it helps. Take good care of yourself and don't forget to close the discussion please.
May the odds be ever in your favour.
Regards XXXXXXX
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