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Vital Signs

Spring 2004

Effective Therapies for Urinary Incontinence Available

VS-Spring04-IncontinenceUrinary incontinence—the involuntary leakage of urine—often goes untreated despite significant advances in corrective therapies, observes Larissa Rodriguez, M.D., urologist at UCLA’s Incontinence and Voiding Dysfunction Center. Loss of bladder control can trigger embarrassment, withdrawal from social situations, and more. “Incontinence is the main reason why the elderly are placed in nursing homes and it has been shown to lead to depression,” Dr. Rodriguez notes.

Women in particular are susceptible to incontinence, particularly during or after pregnancy, hysterectomy or menopause, when pelvic muscles are weaker. Estimates suggest that 30 to 50 percent of American women suffer from the condition, which is often a symptom of a structural, functional or neurological disorder.

Urge incontinence—or overactive bladder—is the urgent need to urinate with an inability to get to a toilet in time. Nerve passages from the bladder to the brain work improperly, causing a sudden bladder contraction. Stress incontinence occurs when pelvic muscles have been damaged, causing the bladder to leak during some type of stress maneuver—sneezing, coughing, laughing, or with exercise. Women can have a combination of stress and urge incontinence.

According to Dr. Rodriguez, behavior modification and biofeedback coupled with medication can effectively treat 70 percent of patients with urge incontinence. Additionally, minimally invasive therapies can retrain pelvic muscles, and avoid more invasive surgeries. For example, during weekly office visits, techniques to stimulate the peripheral nerves in the legs help retrain nerves that contract and relax the bladder. When appropriate, a bladder “pacemaker” inserted under the skin can permanently cure urge incontinence.

Patients with stress incontinence also respond well to behavior modification, pelvic floor exercises, and biofeedback. For women who do not respond to conservative therapies, doctors can perform outpatient surgery to insert a supportive sling under the urethra (the tube through which urine passes and exits the body).

An enlarged prostate is the most common cause of incontinence and voiding dysfunction in men, Dr. Rodriguez notes. Medications and/or minimally invasive treatments to shrink the prostate—radiofrequency, microwave therapy, or needle ablation— can provide relief. Other treatable incontinence conditions in men stem from neurological disorders or side effects from prostate cancer surgery.

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