Incontinence and Voiding Problems
Involuntary loss of urine is termed urinary incontinence. Incontinence can be divided into stress, (leaking with coughing, straining , laughing or activity), urge (loss of urine preceded by sense or urgency to urinate ) or mixed stress/urge incontinence based on symptoms and pathogenesis. Prevalence varies by age, sex, and race. The prevalence of incontinence ranges from 1.5 to 5% in men and from 10 to 30% in women. Roughly 4.6 million Americans suffer from urge incontinence. Forty-five percent of women complain of mixed or urge urinary incontinence. In fact, urinary incontinence afflicts more women than hypertension, diabetes, and depression. Both the severity and prevalence of urge incontinence increases with age and ultimately effects as many men as women. This is exemplified by the fact that more than 50% of nursing home patients are incontinent. Occasionally bladder control problems are a sign of more serious problems such as diabetes or a brain malfunction (neurologic disease).
Another condition closely related to urge incontinence is overactive bladder (OAB). OAB is defined as urgency with or without urge urinary incontinence usually with daytime frequency and nocturia (getting up to urinate at night) in the absence of local or metabolic factors. In the United States and Europe it has been estimated that 16% of population suffers from OAB. Occasionally symptoms of OAB indicate a bladder infection and rarely bladder cancer.
Determining the cause for bladder control problems is crucial to planning treatment. Causes are grouped into: 1. a fallen bladder due to childbirth or genetics, 2. a weak sphincter muscle (worn out washer on a hose), or 3. bladder (detrusor) overactivity. The combination of physical examination, urine testing, and bladder pressure testing (urodynamics) helps sort out these causes. Examination takes minutes while bladder testing involves a 45 minute evaluation with minimal discomfort. It is important in women to determining if weak of pelvic structures (prolapse) exists.
Treatments are categorized as: 1. behavioral training which involving diaries, pelvic muscle exercise, fluid management, 2. drugs to relax bladder or tighten sphincter muscle, and 3. surgeries to tack up bladder, compress urethra or fix vaginal support.
The Department of Urology at the University of Virginia employs state of the art testing and utilizes the latest drugs, minimally invasive surgerys (TVT, SPARC, Trans obturator TOT), artificial urinary sphincter, and standard fascial slings depending on specific patient needs and desires.