Incontinence is the loss of urinary or fecal control, affecting one in six men and one in three women. It can develop at any age, but it tends to be more common later in life. Although often embarrassing, it is highly treatable. Urinary incontinence is the loss of bladder control. Symptoms range from mild leaking to uncontrollable wetting. There are two different types of urinary incontinence. Stress incontinence is caused by weakness in the muscles that keep the bladder closed, which can cause accidents upon laughing, coughing, sneezing, or lifting a heavy object. The second type, overactive bladder, causes a strong urge to urinate, even if there is little to no urine in the bladder. Fecal incontinence is the loss of bowel control. Bowel incontinence can be caused by constipation, damage to structures of the anus and rectum, diarrhea, and pelvic support problems.
UAB Medicine uses a multidisciplinary approach to treat incontinence, working with a variety of experts to establish new therapies for this very common and often embarrassing yet highly treatable condition. Male and female patients of all ages suffering from incontinence are served by one or more departments at UAB, including Urogynecology, Urology, and the UAB Continence Clinic, depending on the exact nature of the condition, the patient’s gender, and whether surgery may be required. Our world-class clinicians work together to provide a comprehensive evaluation for each patient, collaborating when necessary with the UAB Division of Gerontology, Geriatrics, and Palliative Care, and we help train health care providers to recognize, evaluate, and treat incontinence patients.
The National Association For Continence (NAFC) named UAB’s Continence and Urogynecology Care Clinic its first Center of Excellence for Continence Care for 2014-2019. For female patients experiencing incontinence and other pelvic floor disorders, our urogynecology specialists are focused on improving their quality of life with new treatment options, many of which were developed at UAB and don’t always involve surgery. UAB’s Continence Clinic, which cares for both men and women, is one of only eight National Institutes of Health (NIH)-designated Pelvic Floor Disorders Network members, and the clinic has seen more than 6,000 patients since its inception in 1992.
Our active participation in clinical trials means that we continually investigate new drugs and therapies for incontinence, and related research at UAB keeps us on the forefront of important advances and promising new treatments. We have received more than $9 million in research funding, and more than 1,000 clinic patients have participated in related clinical trials, leading to new discoveries and incontinence treatments. This increases the possibility of providing patients with cutting-edge therapies that are not yet available at other medical centers.
A behavioral psychologist works on staff to develop new ways to introduce behavioral treatments and exercises and bladder and bowel control strategies into patient lifestyles to improve their quality of life. In fact, it was UAB Medicine researchers who developed the “freeze and squeeze” urge control method now used nationwide. A UAB study showed that men who do pelvic floor muscle exercises, called Kegel exercises, before prostate cancer surgery regain bladder control faster. Our study also showed that behavioral therapy is more effective than drugs for women with urgency incontinence, as effective as drugs for men with overactive bladder (urgency and frequency of urination), and that it can improve incontinence for men even years after prostate cancer surgery.
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There are many tests available to help determine the exact causes of incontinence.
These may include urinalysis (examination of the urine) and blood tests to check the cells and various blood components, hormones, and chemicals.
A thin tube is placed inside the urethra to view the inside of the urethra and bladder.
These tests are used to check the function of the lower urinary tract, which consists of the bladder, urethra, and the voluntary and involuntary sphincter muscles. Many of these tests can be done at the same time. Urodynamic tests include:
This test records the amount of urine, the time it takes to urinate, and the speed of the urinary stream. It also tests the ability to start and stop urination, and whether or not it is strong or forceful. The test is performed on a special urodynamic chair. After voiding, a catheter is inserted to see how well you empty your bladder.
Postvoid Residual Measurement
A catheter is inserted after voiding to see how much urine remains in your bladder.
For this test, a very small catheter is inserted to measure bladder pressure at various stages. Fluid is infused through the catheter to test how well the bladder muscle stretches during filling, how well it stores fluid, and how well you empty your bladder. A small tube is placed in the rectum, causing only minimal discomfort, in order to isolate the pressure of the bladder muscle itself.
Electromyography (EMG )
The EMG may be performed at the same time as the CMG. For this test, sensor patches are placed on the skin near the urethra and rectum to test the muscle activity of the external sphincter. Muscle activity is recorded on a machine. The patterns of the impulses will show whether the nerve messages are coordinated correctly.
Video imaging is used to take pictures of the bladder during filling and emptying. The imaging equipment may use x-rays or sound waves. If x-ray equipment is used, the liquid used to fill the bladder may be a contrast medium that will show up on the x ray. The pictures and videos show the size and shape of the urinary tract.
leak point pressure measurement – This test determines the lowest amount of pressure and amount of urine that causes leakage. It is performed as a part of the cystometry study.
Pressure Flow Study
This test follows the cystometry study and measures pressures required to urinate.
Anorectal physiology studies – These tests are used to help us characterize how well you sense a fullness of the rectum, your ability to contract and relax your pelvic muscles, and determine whether there is a tear in the anal sphincter muscle.
This checks the tightness of the anal sphincter and its ability to respond to signals, as well as the sensitivity and function of the rectum. A thin, flexible tube is inserted into the anus and rectum, then a small balloon at the tip of the tube is inflated. Pressure monitors inside the tube transmit the muscle impulses to a graph, similar to an electrocardiogram. The procedure is similar to a female pelvic examination and takes about 15 minutes to perform.
A small, balloon-tipped ultrasound probe is inserted into the rectum. The structure of the anal sphincter can be evaluated from the pictures of the as the probe is moved.
Small sensor patches are placed on the skin near the muscles around the anus to check for nerve damage to the sphincter. This is not painful.
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