Urge incontinence is characterized by a sudden uncontrollable urge to urinate and frequent urination. It is often necessary to use a bathroom as frequently as every 2 hours, and bed-wetting is common.
With urge incontinence, the bladder contracts and squeezes out urine involuntarily. Sometimes a large amount of urine is released. Accidental urination can be triggered by
Two bladder abnormalities commonly cause urge incontinence.
The most common is a neurogenic bladder (overactive type), which is caused by brain or spinal cord injury or disease that interrupts nerve conduction above the sacrum and results in loss of bladder sensation and motor control. There are several neurological diseases and disorders associated with a neurogenic bladder, including the following:
Chronic urinary tract infection, bladder stones, and polyps can irritate the bladder and cause detrusor muscle instability, leading to urge incontinence. Detrusor muscle instability without a known cause is also common. It has been suggested that, in these cases, an unidentified dysfunction in muscle or nerve tissue is responsible.
Diuretics increase the amount of urine released from the body. They are commonly used to treat high blood pressure (hypertension) and fluid build-up in the body (edema). Rapid-acting diuretics increase the urgency and frequency of urination in some people, especially the elderly and bedridden. Modifying dosage may alleviate symptoms.
Surgical Treatment of Urge Incontinence
Surgery is recommended only after other treatment options have proven unsuccessful.
Bladder Augmentation - This procedure increases the capacity of a small, hyperactive, or non resilient bladder by adding bowel (intestine) segments or by reducing the muscle-squeezing ability of the bladder (auto augmentation). Patients who are unable to perform self-catheterization (i.e., placement of a urinary catheter by the patient) or who have a kidney disorder, bowel disease, or urethral disease are not candidates for bladder augmentation.
Segments from the last part of the small intestine (ileum), the first part of the large intestine (cecum), or the junction between the small and large intestines (ileocecum) can be used to enlarge the bladder. The bladder is opened at the dome and cut on right angles on each side. The bowel segment is joined to the bladder with sutures.
In autoaugmentation, the smooth muscle that contracts the bladder to expel urine (detrusor) is cut out of the dome of the bladder, leaving the mucous membrane intact. This results in reduced muscle contraction and improved function in an overactive bladder.
Postoperative complications include urine leakage, continued incontinence, and kidney problems. Long-term risks include bladder stones, bladder cancer, and incontinence during and after pregnancy.
InterStim® therapy is a reversible treatment for people with urge incontinence caused by overactive bladder who do not respond to behavioral treatments or medication.
InterStim is an implanted neuro stimulation system that sends mild electrical pulses to the sacral nerve, the nerve near the tailbone that influences bladder control muscles. Stimulation of this nerve may relieve the symptoms related to urge incontinence.
Prior to implantation, the effectiveness of the therapy is tested on a outpatient basis with an external InterStim device.
For a period of 3 to 5 days, the patient records voiding patterns that occur with stimulation. The record is compared to recorded voiding patterns without stimulation. The comparison demonstrates whether the device effectively reduces symptoms. If the test is successful, the patient may choose to have the device implanted.
The procedure requires general anesthesia. A lead (a special wire with electrical contacts) is placed near the sacral nerve and is passed under the skin to a neuro stimulator, which is about the size of a stopwatch. The neuro-stimulator is placed under the skin in the upper buttock.
Adjustments can be made at the doctor’s office with a programming device that sends a radio signal through the skin to the neuro stimulator. Another programming device is given to the patient to further adjust the level of stimulation, if necessary. The system can be turned off at any time.
Possible adverse effects include the following:
Nonsurgical Treatment of Urge Incontinence
Treatments most commonly used for urge urinary incontinence are biofeedback electrical stimulation, bladder training with timed voiding, and surgery.
The above opinionated views and information serves to educated and informed consumer . The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. .It should not replaced professional advise and consultation. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions
Copyright © 2004
Irene Nursing Home Pte Ltd