Jay D. Burstein M.D.

Urologist - Board Certified

New Treatment Options for Urinary Incontinence
Most people believe that Urinary Incontinence, the involuntary leakage of urine, is a normal part of growing old. Advertisements abound to promote the use of disposable undergarments as an appropriate method for controlling this problem.

Incontinence, however, is not normal at any age --- 5 or 85. It is a symptom of an underlying disorder that is treatable and even curable through the use of diet, exercise, medication, or as a last resort, surgery. Many are surprised to learn that there are at least 13 million Americans suffering from urinary incontinence. More surprising is that only one in four seek help. People are just too embarrassed or simply not aware that there is treatment available. At least 80 percent of those who suffer from this disorder can be cured or treated with significant improvement. A minority may choose absorbent padding, but most can be rid of the cost and inconvenience of these products through other options.

Types of Incontinence
Many women in their 40’s who have given birth to children leak a small amount of urine with a laugh, cough, sneeze, or with exercise. This is called ?stress incontinence? and is the most common type in this age group. This occurs from muscle weakness of the pelvic floor muscles that support a woman’s bladder. Pregnancy and repeated childbirth can stretch these muscles. A lack of estrogen in post-menopausal women can aggravate the damage and lead to leakage. During exercise or sneezing, muscles are tugged downward and pressure around the bladder increases. The muscle of the bladder that controls emptying, called the urinary sphincter, relaxes in this situation and is not strong enough to keep the bladder shut, resulting in a urinary leak.

Another type of incontinence is called ?urge incontinence?. This is more common in both sexes, usually over the age of 60. This causes an abrupt and unstoppable desire to urinate. It can result from an infection or even a bladder tumor causing the bladder to contract involuntarily. Some people even have combination of incontinence called ?mixed incontinence?, a combination of both ?stress and urge?.

Other people may have ?overflow incontinence? which is produced by physical obstruction that prevents the bladder from emptying completely. In women, the blockage may be caused by a previous operation. In men, it may be caused by an enlarged prostate gland.

Diagnosis and Treatment
The first step is to recognize that this is a treatable disease, and, in most cases, curable. A physician who specializes in incontinence will try to determine the exact type of incontinence, the possible causes, and then offer a treatment program. Patients are often asked to keep a voiding diary consisting of a record of bathroom habits. There are also tests available to see if the bladder empties normally.
Physical examinations and testing for urinary tract or vaginal infections are also common procedure. A careful history of prescription and over-the-counter drugs is an important part of the evaluation as certain sedatives, antidepressants, diuretics, sleeping pills and cold tablets can cause side effects including incontinence. Very often, just a change in medication can bring dramatic relief of urinary leakage. The use of caffeine can be notorious in producing irritable bladder symptoms.

Federal guidelines from the Department of Health and Human Services last year recommended behavioral treatments as a first option (such as a change in diet), then the use of drugs, and, lastly, surgery. Other behavioral methods include bladder retraining, biofeedback techniques and pelvic muscle rehabilitation.

Conservative treatment of stress incontinence begins with the use of Kegel exercises. This helps to strengthen the muscles that control the stop and start of urination. These are done several times throughout the day, sometimes with weights inserted in the vagina. Other times, it can be properly taught using biofeedback techniques. Sometimes, mild stress incontinence can be treated by the use of a tampon or a pessary. This causes compression of the urinary tract and can help restore support to the muscles surrounding the bladder.

Also available are medications that help to increase the contraction of the urinary sphincter control muscles and can be effective for mild cases of stress incontinence. Sudafed, or medications containing its active ingredient pseudoephedrine, are available as over the counter cold medications but may elevate blood pressure with long term use. ORNADE and other medications that contain its active ingredient, phenylpropanolamine, have been associated with increased risk of stroke and are no longer available. A promising new medication called duloxetine has been shown to improve symptoms of stress incontinence in limited clinical trials. It is well tolerated with minimal side effects and final phase studies are being planned. If all conservative measures are ineffective, there are a variety of operations that are designed to place the support muscles of the bladder back in their proper position. These can typically be done as an outpatient or require a one or two-night hospital stay depending on the complexity of the repair and involve minimally invasive surgical techniques. The success rate for these procedures is 80-90 percent.

Urgency incontinence is usually treated by using antispasmodic prescription drugs, which are generally well tolerated but can have unpleasant side effects such as dry mouth. These eliminate the urge to urinate in approximately one-half of patients. For those unable to tolerate side effects, newer medicines called DETROL LA and DITROPAN XL are as effective as other medications but have fewer side effects. Another option soon to be available is an oxybutinin skin patch that is changed twice a week. This is an antispasmodic preparation that has been shown to limit side effects and may offer an alternative for those patients unable to tolerate oral medication. Timed voiding and other behavioral treatments including biofeedback can improve a significant proportion of other patients.

Today, men with overflow incontinence who suffer from an enlarged prostate have a variety of treatment options. Many can be treated by prescription medications, including Proscar, Cardura, Hytrin and Flomax. However, if an enlarged prostate does not respond to medications, prostate surgery is usually indicated. Because of the widespread use of medication, the number of men undergoing prostate surgery has dramatically fallen over the past ten years. Newer outpatient procedures utilizing microwave and laser therapies may provide an effective alternative to medication, and in some cases even surgery.

The difficulty in treating urinary incontinence is basically a lack of awareness in the general public to the availability of newer, non-invasive treatments that control this often-debilitating problem. The media is currently targeting urinary incontinence. Articles routinely appear in magazines such as Good Housekeeping, and Cosmopolitan. The October 1997 issue of Consumer Reports has an excellent review article on urinary incontinence. This contemporary report states, ? In recommending treatment for this disease, it is important to seek out a doctor, ideally a specialist. Relying only on absorbent padding deprives people of the change for longer term, more effective relief.? Millions of people suffer needlessly from urinary incontinence. It is the hope that in time the public will understand the multitude of treatment options available to alleviate, and even cure, this disorder.

NEW TREATMENT OPTIONS FOR OVERACTIVE BLADDER
Most people believe that overactive bladder, the involuntary leakage of urine, is a normal part of growing old. Overactive bladder, however, is not normal at any age. It is a symptom of an underlying disorder that is treatable and even curable through the use of diet, exercise, medication, or, as a last resort, surgery. Surprisingly, there are at least 13 million Americans who have overactive bladder, yet only one-fourth seeks help. People are just too embarrassed or are not aware that there is available treatment. At least 80 percent of people suffering from overactive bladder can be cured or treated with significant improvement.

Types of Incontinence
Leakage of urine with a laugh, cough, sneeze or exercise is called "stress incontinence". This occurs from muscle weakness of the pelvic floor muscles that support the bladder. Pregnancy and repeated childbirth can stretch these muscles and a lack of estrogen in post-menopausal women can aggravate the damage that leads to leakage. Men can have this problem after prostate cancer surgery.

Another type of incontinence is called "urge incontinence" or overactive bladder. This is more common in both sexes. This causes an abrupt and unstoppable desire to urinate. It can result from an infection, chronic inflammation or even a bladder tumor that causes the bladder to contract involuntarily.

Other people may have "overflow incontinence" which is produced by physical obstruction that prevents the bladder from emptying completely. In women, the blockage may be caused by a previous operation. In men, it may be caused by an enlarged prostate gland.

Diagnosis and Treatment
The first step is to recognize that overactive bladder is a treatable disease and in most cases, curable. A physician who specializes in incontinence will try to determine the exact type of incontinence, the possible causes, and then offer a treatment program. Federal guidelines from the Department of Health and Human Services recommend behavioral treatments as a first option (such as changing the diet), then the use of medication, and lastly, surgery.

Conservative treatment of stress incontinence begins with the use of Kegel exercises. This helps to strengthen the muscles that control the stop and start of urination. This causes compression of the urinary tract and can help restore support to the muscles surrounding the bladder. Also available are several medications that contain pseudoephedrine that help to increase the contraction of the urinary sphincter control muscles

Overactive bladder is usually treated by using antispasmodic prescription drugs such as DITROPAN XL and DETROL LA which are generally well tolerated but may have unpleasant side effects such as dry mouth.

Men with overflow incontinence who suffer from an enlarged prostate have a variety of treatment options. Many can be treated by newer medications including Proscar, and Flomax. Complimentary alternatives such as Saw Palmetto and Africanus Pygeum are herbal extracts which may be effective for those with minimal to moderate symptoms.

Conclusion
The difficulty in treating overactive bladder is basically a lack of awareness of the general public to the availability of newer, non-invasive treatments for control of this often debilitating problem. The October 1997 issue of Consumer Reports has an excellent review article on urinary incontinence and overactive bladder which states "In recommending treatment for this disease, it is important to seek out a doctor, ideally a specialist. Relying only on absorbent padding deprives people of the chance for longer term, more effective relief."

NEW TREATMENT OPTIONS FOR BLADDER CONTROL
Most people believe that urinary incontinence, the involuntary loss of bladder control, is a normal part of growing old. Incontinence, however, is not normal at any age. It is a symptom of an underlying disorder that is treatable and even curable through the use of diet, exercise, medication, or, as a last resort, surgery. Surprisingly, there are at least 13 million Americans who have bladder control problems, yet only one-fourth seeks help. People are just too embarrassed or are not aware that there is available treatment. At least 80 percent of people suffering from loss of bladder control can be cured or treated with significant improvement.

Types of Incontinence
Leakage of urine with a laugh, cough, sneeze or exercise is called "stress incontinence". This occurs from muscle weakness of the pelvic floor muscles that support the bladder. Pregnancy and repeated childbirth can stretch these muscles and a lack of estrogen in post-menopausal women can aggravate the damage that leads to leakage. Men can have this problem after prostate cancer surgery.

Another type of incontinence is called "urge incontinence". This is more common in both sexes. This causes an abrupt and unstoppable desire to urinate. It can result from an infection, chronic inflammation or even a bladder tumor that causes the bladder to contract involuntarily.

Other people may have "overflow incontinence" which is produced by physical obstruction that prevents the bladder from emptying completely. In women, the blockage may be caused by a previous operation. In men, it may be caused by an enlarged prostate gland.

Diagnosis and Treatment
The first step is to recognize that loss of bladder control is a treatable problem and in most cases, curable. A physician who specializes in incontinence will try to determine the exact type of incontinence, the possible causes, and then offer a treatment program. Federal guidelines from the Department of Health and Human Services recommend behavioral treatments as a first option (such as changing the diet), then the use of medication, and lastly, surgery.

Conservative treatment of stress incontinence begins with the use of Kegel exercises. This helps to strengthen the muscles that control the stop and start of urination. This causes compression of the urinary tract and can help restore support to the muscles surrounding the bladder. Also available are several medications that contain pseudoephedrine that help to increase the contraction of the urinary sphincter control muscles

Urgency incontinence is usually treated by using antispasmodic prescription drugs such as DITROPAN XL and DETROL LA which are generally well tolerated but may have unpleasant side effects such as dry mouth.

Men with overflow incontinence who suffer from an enlarged prostate have a variety of treatment options. Many can be treated by newer medications including Proscar, and Flomax. Complimentary alternatives such as Saw Palmetto and Africanus Pygeum are herbal extracts which may be effective for those with minimal to moderate symptoms.

Conclusion
The difficulty in treating loss of bladder control is basically a lack of awareness of the general public to the availability of newer, non-invasive treatments. The October 1997 issue of Consumer Reports has an excellent review article on urinary incontinence which states "In recommending treatment for this disease, it is important to seek out a doctor, ideally a specialist. Relying only on absorbent padding deprives people of the chance for longer term, more effective relief."

NEW TREATMENT OPTIONS FOR BLADDER INCONTINENCE
Most people believe that bladder incontinence, the involuntary leakage of urine, is a normal part of growing old. Incontinence, however, is not normal at any age. It is a symptom of an underlying disorder that is treatable and even curable through the use of diet, exercise, medication, or, as a last resort, surgery. Surprisingly, there are at least 13 million Americans who have bladder incontinence, yet only one-fourth seeks help. People are just too embarrassed or are not aware that there is available treatment. At least 80 percent of people suffering from bladder incontinence can be cured or treated with significant improvement.

Types of Incontinence
Leakage of urine with a laugh, cough, sneeze or exercise is called "stress incontinence". This occurs from muscle weakness of the pelvic floor muscles that support the bladder. Pregnancy and repeated childbirth can stretch these muscles and a lack of estrogen in post-menopausal women can aggravate the damage that leads to leakage. Men can have this problem after prostate cancer surgery.

Another type of bladder incontinence is called "urge incontinence". This is more common in both sexes. This causes an abrupt and unstoppable desire to urinate. It can result from an infection, chronic inflammation or even a bladder tumor that causes the bladder to contract involuntarily.

Other people may have "overflow incontinence" which is produced by physical obstruction that prevents the bladder from emptying completely. In women, the blockage may be caused by a previous operation. In men, it may be caused by an enlarged prostate gland.

Diagnosis and Treatment
The first step is to recognize that bladder incontinence is a treatable disease and in most cases, curable. A physician who specializes in bladder incontinence will try to determine the exact type of incontinence, the possible causes, and then offer a treatment program. Federal guidelines from the Department of Health and Human Services recommend behavioral treatments as a first option (such as changing the diet), then the use of medication, and lastly, surgery.

Conservative treatment of stress incontinence begins with the use of Kegel exercises. This helps to strengthen the muscles that control the stop and start of urination. This causes compression of the urinary tract and can help restore support to the muscles surrounding the bladder. Also available are several medications that contain pseudoephedrine that help to increase the contraction of the urinary sphincter control muscles

Urgency incontinence is usually treated by using antispasmodic prescription drugs such as DITROPAN XL and DETROL LA which are generally well tolerated but may have unpleasant side effects such as dry mouth.

Men with overflow incontinence who suffer from an enlarged prostate have a variety of treatment options. Many can be treated by newer medications including Proscar, and Flomax. Complimentary alternatives such as Saw Palmetto and Africanus Pygeum are herbal extracts which may be effective for those with minimal to moderate symptoms.

Conclusion
The difficulty in treating bladder incontinence is basically a lack of awareness of the general public to the availability of newer, non-invasive treatments for control of this often debilitating problem. The October 1997 issue of Consumer Reports has an excellent review article on urinary incontinence which states "In recommending treatment for this disease, it is important to seek out a doctor, ideally a specialist. Relying only on absorbent padding deprives people of the chance for longer term, more effective relief."

BLADDER TRAINING
The Purpose of This Program is to Gradually Increase Your Bladder Capacity and Decrease the Frequency of Urination.

After an extended period of time of frequent urination the bladder sets its "thermostat" at a very low volume. This "thermostat" needs to be reset at a higher volume.

Concentrated urine is "irritating" to your bladder and makes you feel like you need to urinate at lower volumes than dilute urine. Certain dietary factors can also be irritating to your bladder and make you feel the need to pass urine frequently.

To encourage your bladder to hold larger volumes, the urine going into your bladder should be as dilute and "non-irritating" as possible.

When you first start drinking more water, you may find that the frequent urination seems worse until your bladder starts to enlarge gradually.

The best way to monitor your progress is to keep a voiding diary 1 or 2 days a week. Keep track of how much urine you pass and how often you pass it. Gradually you will see the volumes of urine that you pass increase. We have forms to help you keep track of this.

To Start Your Bladder Training Program:

1. Eliminate Bladder Irritants:
2. 1. Coffee
3. 1. Tea
4. 1. Carbonated Beverages
5. 1. Alcohol
6. 1. Chocolate
7. 1. Tomatoes
8. 1. Acidic Fruits: cranberry, orange, grapefruit, lemon, apple
9. Drink at least 1 quart of water per day, increasing gradually to 2 quarts a day
10. When you get the urge to void, try to hold it for 5 extra minutes before going to the washroom. Each week add 5 minutes to the length of time you hold the urine after you have the urge.
11. The goal is to hold 300-400cc in your bladder and urinate every 2-4 hours can decrease gradually your fluid intake to decrease the frequency of urination. Half of your fluid intake should always be water.
12. You should see improvement within 2-3 months

BIOFEEDBACK
The Purpose of this Program is to Gradually Improve Bladder Control by Increasing the Strength of the Pelvic Muscles.
Bladder control problems are often caused by weakness of the muscles of the pelvis. For some patients the muscles may have been weak for years, and for others, the weakness has been worsened by childbirth or medical problems. The traditional way to strengthen these muscles is with Kegel exercises. With biofeedback therapy, some patients can be taught to grip and squeeze with the pelvic muscles. Repeated on a regular schedule over long periods, these exercises are often effective. However, many patients cannot grip well with these muscles and, for them, electrical stimulation can be used. Electrical stimulation uses skin pads placed on the abdomen and a small sensor placed in the vagina (rectum in a male) that passes a painless electric current into the tissues. As the current passes into the body's tissues, it can cause the nerves to stimulate the muscles to contract. By using repeated treatments, the muscles can be strengthened and bladder control improved. Six to eight weekly sessions with our nurse therapist are usually necessary. A durable result can only be obtained by regular strengthening of the pelvic muscles. After each session, the patient is encouraged to practice the Kegel exercise at home in a regular, routine manner.