Nőgyógyászati, Szülészeti és Ultrahang Magánrendelő Debrecen - Dr. Zatik János

Urinary Incontinence

Urinary Incontinence and Overactive Bladder (OAB) Incontinence is a medical condition resulting in the uncontrollable leakage of urine. This leakage can happen because the patient has a strong urge to urinate and cannot hold it. The bladder muscle is supposed to contract to empty the bladder only during urination. An (OAB) muscle contracts unpredictably causing frequent urination or sudden strong urges to urinate with or without leakage of urine. When a person experiences urinary incontinence, it is not because his or her bladder is too full.We often find that only a small amount of urine in the bladder can result in an urge to urinate. Overactive or hyperactive bladder (OAB) affects more than 50% of women of all ages, its incidence increases significantly with age.   Urge Incontinence Urge incontinence is a component of overactive bladder. Urge incontinence occurs when the bladder contracts involuntarily (detrusor overactivity). Symptoms include the sudden, uncontrollable need to urinate which can lead to wetting accidents. The urge to urinate can also be especially strong at night (nocturia) or may lead to accidental leakage while sleeping (enuresis). Stress Incontinence The primary symptom of stress incontinence is leakage due to activities that apply pressure to a full bladder. High-impact exercise poses the greatest risk for leaking. But stress incontinence can occur with even minor activities, such as: - Coughing - Sneezing - Laughing - Running (sometimes even standing can produce leakage) - Lifting Stress incontinence occurs when the muscles around your urethra become too weak to prevent the urine in your bladder from escaping. Many women experience this after pregnancy and menopause, and adjust their lives by wearing pads and diapers. It’s important to remember that stress incontinence is not the same as overactive bladder They have different symptoms and different treatments.   Overactive Bladder 1. "Wet overactive bladder", also called "urge urinary incontinence", is urinary urgency that leads to leakage of urine. 2. "Dry overactive bladder" is urinary urgency and frequency without leakage of urine OAB adversely affects a person’s quality of life. OAB sufferers report greater incidences of poor quality of sleep, depression, embarrassment, and social isolation due to fear of leakage. OAB really is: When nerves send the wrong signal to the bladder. Filling, holding and emptying your bladder requires complex coordination among your kidneys, bladder, brain, spinal cord, ureters and urethra (which both transport urine) and the muscles in your bladder and pelvic floor. Patient with an overactive bladder isn't always and necessarily incontinent. Mixed Symptoms (overactive bladder and Stress Incontinence) Many people who have the symptoms of overactive bladder also suffer from stress incontinence. Unfortunately, there is no single treatment that works for both conditions. So if you have mixed symptoms, each will have to be treated separately. Symptoms The most common symptom of overactive bladder is urinary urgency, which is a sudden, intense desire to urinate. Urgency may occur with (wet overactive bladder) or without (dry overactive bladder) leakage of urine. This can occur in specific situations such as, when hearing or touching running water or getting close to a bathroom. With wet overactive bladder, a person may be unable to stop leakage before reaching the toilet. Urine loss is usually in large amounts. Other symptoms of overactive bladder are urinary frequency and nocturia. Urinary frequency is urinating more than eight times per day. Nocturia is being awakened by the urge to urinate more than one time per night. Differences beetween Overactive Bladder (OAB) and Stress Incontinence (Str.Inc) Symptoms OAB Str.Inc Urgency (strong, sudden desire to void) Yes No Frequency with urgency (> 8 times/24 hrs) Yes No Leaking during physical activity,coughing No Yes Amount of urinary leakage with each episode of incontinence Many Few   (If yes)   Ability to reach toilet in time following an urge to void No Yes Waking to pass urine at night Tipical Rare Cause Overactive bladder is caused by involuntary bladder contractions, as the bladder fills. This is believed to be due to malfunctioning bladder nerves The cause of OAB is unknown. Risk factors may cause or contribute to symptoms similar to OAB including: - Urinary tract infection (UTI) - Factors that block bladder emptying (constipation, tumors, stones, previous bladder surgery pelvic surgery) - Diabetes, which can cause excess urine production - Smoking and diet .Excess consumption of caffeine or alcohol and nicotine. The nicotine in cigarettes decreases blood flow to the bladder muscles, which can cause abnormal contractions and leaks - Medications that cause a rapid increase in urine production diuretics.Antidepressants and muscle relaxants - age,menopause hypoeostregen status - obesity,excess weight puts undue pressure on the bladder and the pelvic floor muscles - presence of neurological conditions such stroke, Parkinson's disease, multiple sclerosis, - chronic cough, whether it's from smoking or another condition, puts extra pressure on the bladder as well   Diagnosis Although incontinence is generally mild and very treatable, as with a urinary tract infection, it is important to have an exam to rule out other possible conditions. For example, incontinence is one of the first signs of a neurological disorder like multiple sclerosis or Parkinson’s disease. Determining the cause is instrumental in discovering which overactive bladder treatment is best for you and protecting your long term health. Treatment of overactive bladder and incontinence   Non surgical treatment Kegel Exercises,Pelvic Floor Therapy, Elektrosimulation,Behavioral Therapy Behavioral Therapy is to help train women to behaviorally control mild to moderate incontinence. For example, certain foods and beverages contribute to urgency or increased frequency (i.e., urge incontinence). Therefore, many women find that reducing or eliminating their caffeine intake lessens these symptoms. Also, timed voiding and bladder retraining, which involve urinating on a set schedule during the day regardless of the need or urge to void, is often helpful. Kegel exercises are contractions of the pelvic floor muscles. Pelvic floor muscle contraction at the appropriate time can inhibit bladder overactivity controlling urinary urgency, frequency, and urge incontinence. Electrical stimulation, and bladder training to help women develop better control over urge urinary incontinence. Low-Dose Vaginal Estrogen Low-dose vaginal estrogen replaces declining estrogen in urethral tissues and has been shown to decrease symptoms of urinary urgency and frequency. Low-dose vaginal estrogen comes in a cream . suppository (Ovestin, Estrocad,Vagifem). Overactive Bladder Medications There are several brands of overactive bladder medications on the market. These medications work by relaxing the bladder muscle. Side effects are usually mild and include dry mouth, dry eyes, blurred vision, urinary retention, constipation, dizziness, or drowsiness. Changing the brand or dose of medication can decrease side effects. To learn about the different brands of overactive bladder medications, click on the links below: Anticholinergics include - Propantheline (ProBanthine) has been replaced by newer anticholinergics with fewer side effects. - Oxybutynin (Ditropan, Oxytrol) - Tolterodine (Detrol) - Hyoscyamine (Levbid, Cystospaz) - Trospium (Sanctura) - Darifenacin (Enablex) - Solifenacin (Vesicare) - Fesoterodine (Toviaz) Cube and ring Pessary Pessaries are an effective tool for the non-surgical treatment of a variety of gynecologic problems. Commonly used for management of pelvic support defects. Pessaries are also used to treat stress urinary silicone pessaries and Cube pessary, may be used to relieve the symptoms of a cystocele or rectocele as well as a second or third-degree uterine prolapse. a.)Silicone cube b.)Vaginal weight balls c.)Mayer/ Portex pessaries   Surgical treatment of Overactive Bladder Botox Studies are currently underway to evaluate the effectiveness of injecting botulinum toxin into the bladder muscle to control overactive bladder. We do not currently use botox to treat these conditions at Aguirre Specialty Care. Surgical treatment of incontinece - Tension-free vaginal tape (TVT) surgery - Bladder suspension procedures:MKK and Burch operatio - Vaginal Hysterectomy with vaginal wall plastic-operation - Retropubic suspension - Urethral sling - Sacral nerve stimulation (SNS) - Urethral bulking