Monday, January 23, 2023

Bladder Leakage In Your 20s

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A Woman In Her Twenties With Urinary Incontinence

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Drammen Hospital, Vestre Viken Hospital Trust

Thomas F. Næss-Andresen, senior consultant and specialist in general surgery and urology.

The author has completed the ICMJE form and reports no conflicts of interest.

Drammen Hospital, Vestre Viken Hospital Trust

Anniken Haslund, specialist in radiology and head of section.

The author has completed the ICMJE form and reports no conflicts of interest.

Anna Bjerre, MD PhD, specialist in paediatrics and head of section.

The author has completed the ICMJE form and reports no conflicts of interest.

Department of Obstetrics and Gynaecology

Drammen Hospital, Vestre Viken Hospital Trust

Wolfgang Michael Eichstetter, senior consultant and specialist in obstetrics and gynaecology. He has extensive experience of urogynaecology and surgery.

The author has completed the ICMJE form and reports no conflicts of interest.

Department of Surgery

Drammen Hospital, Vestre Viken Hospital Trust

Gunnar Uwe Walther Ebner, senior consultant and specialist in general surgery and urology. He has extensive experience of laparoscopy and robot-assisted surgery, and has a particular interest in the kidneys and prostate gland.

The author has completed the ICMJE form and reports no conflicts of interest.

A woman in her twenties was referred to a gynaecological outpatient clinic after suffering urinary incontinence her entire life. We present a rare cause of urine leakage in adult women.

Table 1

Urodynamic tests and clinical findings.

Figure 1 Figure 2 Figure 3

Causes Of Total Incontinence

Total incontinence is when your bladder cannot store any urine at all. It can mean you either pass large amounts of urine constantly, or you pass urine occasionally with frequent leaking in between.

Total incontinence can be caused by:

  • a problem with your bladder from birth
  • injury to your spinal cord this can disrupt the nerve signals between your brain and your bladder
  • a bladder fistula a small, tunnel like hole that can form between the bladder and a nearby area, such as the vagina

Table : Impotence And Incontinence

The reported statistics on the likelihood of developing impotence or incontinence after prostate cancer treatment vary widely, as shown by the ranges below.

Procedure 30%50% 2%

How did the operation go? And when did it become apparent that you might take longer to recover than you had been led to believe?

The operation went fine. I went back to work very quickly, and in most respects I felt fine. I was incontinent immediately after surgery, but I was led to believe that the problem would straighten itself out within a few weeks or months. But it didnt.

Did you share your concerns about incontinence with your surgeon?

I did, during follow-up visits after the surgery. I probably visited him three to four times during the first six months after surgery. He told me the problem would get better, and for the first month or two, I believed that. But as time went on, nothing was getting any better.

And he didnt seem to care. In a typical visit, I waited a half hour or an hour to see him for literally five minutes, and then he moved on to the next person. So I finally gave up on him.

What sort of problems were you experiencing?

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What Causes Bladder Leaks

There are two main types of urinary incontinence:

Stress incontinence

If you have this type, activities that raise the pressure inside your abdomen cause urine to leak through the ring of muscle in your bladder that normally holds it in. Coughing, sneezing, jumping and lifting heavy objects could lead to a leak.

Going through childbirth, smoking or being overweight can raise the risk of stress incontinence for women, Wright says. Stress incontinence in men is rare, and when it arises, its often due to prostate cancer treatment, such as radiation or surgery.

Urge incontinence

With this type, your brain, spinal cord and bladder dont work together properly to allow you to hold and release urine at the right time. Your bladder may suddenly empty itself without warning. Or you may feel like you need to urinate frequently, a problem called overactive bladder.

Some diseases that affect the nervous system, such as multiple sclerosis or stroke, can cause this kind of incontinence, says Wright. In men, an enlarged prostate may be the culprit. But in many cases, doctors dont know what causes urge incontinence.

It is possible to have both types of incontinence at the same time.

TRY IT: Keep Records

Your doctor will want to know as much as possible about your bladder leakswhen they occur, how much urine comes out, and what youre doing when leaks happen. Consider keeping a diary of when you urinate and when you have leaks, recommends Wright.

Diagnosis Of Urinary Incontinence

Always Discreet 6 Packs x 20 Pads Small Incontinence ...

The first step in treating incontinence is to see a doctor. He or she will give you a physical exam and take your medical history. The doctor will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or had surgery. Your doctor also may do a number of tests. These might include:

  • Urine and blood tests
  • Tests that measure how well you empty your bladder

In addition, your doctor may ask you to keep a daily diary of when you urinate and when you leak urine. Your family doctor may also send you to a urologist, a doctor who specializes in urinary tract problems.

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Leaking Urine: Why It Happens And How To Treat It

Maybe a little bit of pee squeaked out when you sneezed. Maybe it happened on your runand this time, your shorts are kind of wet. Or maybe you have the sudden urge to go and don’t quite make it to the toilet on time.

Leaking urine happens. In fact, more than 25 million people in the US experience urine leakage every day, according to the National Association for Continence . This loss of bladder control is known as urinary incontinence. Here’s what you need to know about the conditionand how to get help.

Biofeedback For Incontinence After Protatectomy

Biofeedback is a widely used technique that helps people understand how to control their body functions, including the urinary control. It has proved its efficiency in helping many men regain their urinary control.

Biofeedback therapy uses computer graphs and audios to make it easier for you to locate the muscles you a are working on. It is a teaching tool that instructes you how to strengthen your muscles.

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Other Types Of Urinary Incontinence

  • Overflow incontinence This occurs when a person is unable to empty their bladder completely and it overflows as new urine is produced. It’s often found in people with diabetes or spinal cord injuries.
  • Mixed incontinence You show evidence of more than one type.
  • Functional incontinence This type of incontinence has less to do with a bladder disorder and more to do with the logistics of getting to a bathroom in time. It’s usually found in elderly or disabled people who have normal or near normal bladder control but cannot get to the toilet in time because of mobility limitations or confusion.
  • Nocturia The need to urinate twice or more during the night, usually affecting men and women over the age of 60. In men, nocturia can be a symptom of an enlarged prostate.

Biofeedback For Pelvic Floor Muscles

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Pelvic floor muscles training with biofeedback something that we have all heard of in passing when it comes to bladder leakage.

Pelvic floor muscle training with biofeedback tells you how well you performed your Kegel exercises and reports those results back to you.

Electrodes are attached or inserted to send signals to a monitor to help you treat bladder leakage. Biofeedback is good! However, biofeedback may not effective if you are unable to control your muscles.

Biofeedback for pelvic floor muscles is excellent if you have pelvic floor muscle tone! Biofeedback uses electrodes that are attached or inserted to send signals to a monitor to help you treat bladder leakage.

While performing pelvic floor workouts with biofeedback, you must give it your full attention to be effective. Focusing on the exercise, the correct muscles, and timing is important to regain bladder control with biofeedback. Biofeedback tells you how well you performed your Kegel exercises and reports those results back to you!

Biofeedback may not be the most effective if you are unable to control your pelvic floor muscles in the first place. Since it shows you muscle movement, if you are unable to move your pelvic floor muscles biofeedback might be a little difficult!

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Incontinence A Big Problem For Young Women

Among teens and young women, incontinence problems are typically related to sports injuries, says Pamela Moalli, MD, a professor of urogynecology at the University of Pittsburgh Magee-Womens Research Institute. “About 20% of college athletes report leakage of urine during sports activities,” she tells WebMD.

“Women in high-impact sports are at highest risk — parachuters, gymnasts, runners,” says Moalli. “In these sports, you’re hitting the ground hard, which can damage pelvic muscles and connective tissue that support the bladder.”

Many young women have pre-existing biological reasons putting them at higher risk, says Niall Galloway, MD, FRCS, professor of urology and director of the Emory Continence Center at Emory University School of Medicine in Atlanta.

“It runs in families,” he tells WebMD. “Just as bad eyesight runs in families, so can weak pelvic muscles. It’s not that they’ve been overdoing it with exercise. It’s just that they’ve reached the tolerance of their own tissues.”

For these girls and women, simply wearing a tampon or pessary — a device similar to a diaphragm — during exercise is a good solution, says Galloway. “They just need a little something to support those pelvic tissues, something to put pressure on the urethra.”

What Are The Different Surgeries For Incontinence

There are three main types of surgical treatments for men who have incontinence following a RP:

  • Urethral bulking procedures are minimally invasive treatments performed endoscopically . A certain material is injected just underneath the lining of the urethra. This makes the urinary passageway smaller and can lead to an improvement in incontinence. This is usually performed as an outpatient procedure, either with or without anesthesia. You can often return to normal activity immediately. Since your body usually reabsorbs the material over time, this procedure often needs to be repeated every 9-15 months as the incontinence may recur. The risks of this procedure are generally minor and can include, but are not limited to, bleeding, urinary tract infection, and temporary urinary retention. Rarely, patients may feel that their incontinence is made worse by the procedure.
  • Talk to your urologist for more details about your options and the risks and benefits of your situation.

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    Help With Urinary Incontinence

    Urinary Incontinence is a challenge for more than a third of those 65 and over. Bladder control exercises can help you regain control of your bladder from urinary incontinence and help you prevent incontinence in the future.

    Urinary incontinence in women can be caused by a variety of factors. In addition to the weakening of bladder muscles that comes with age, women go through pregnancy, childbirth, and menopause that can affect the urinary tract, bladder, and pelvic floor muscles.

    Anatomy also plays a role. The female urethra is much shorter than the male urethra, which can make women more likely to develop UI if the urinary tract has been damaged. The two most common forms of UI are stress incontinence and urge incontinence.

    Stress incontinence is characterized by leaking urine while jumping, coughing, sneezing, or doing any activity that puts stress on the bladder.

    Urge incontinence is characterized by the frequent and strong urge to urinate, even if youve just emptied your bladder. This form of incontinence is very similar to overactive bladder , but it becomes incontinence when the intense urge causes your bladder muscles to release urine, even if youre nowhere near the bathroom.

    What Can You Do To Relieve Urinary Incontinence

    BROOKE BURKE

    Urinary incontinence almost never goes away on its own. But there are steps you can take to help relieve your symptoms.

    “Alleviating urinary incontinence starts with understanding which type of incontinence you’re experiencing and what’s causing it,” says Dr. Lindo. “A specialist such as a urogynecologist can help provide those answers for you, as well as help you understand which behavior modifications and other treatments will be most effective for alleviating your incontinence.”

    Weight loss almost always helps relieve urinary incontinence because it reduces the amount of pressure being placed on your pelvic floor. In fact, losing just 5 percent of your weight can improve your urinary symptoms by up to 70 percent.

    Similarly, pelvic floor exercises, such as Kegels, can help reduce symptoms of either type of incontinence. In the case of stress incontinence, pelvic floor exercises are a way to restrengthen your weakened muscles. For urge incontinence, these exercises can help calm and retrain your bladder.

    “For women experiencing stress incontinence after childbirth, sometimes weight loss and postnatal pelvic floor exercises are all it takes for symptoms to resolve over time,” adds Dr. Lindo.

    Depending on the type of incontinence you’re experiencing, your doctor may suggest trying additional modifications.

    Behavioral modifications for stress incontinence:

    • Weight loss
    • The use of a vaginal insert, such as a tampon, while exercising

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    Risk Of Bias Assessment

    The Newcastle Ottawa scale, which evaluates cohort selection, comparability and outcomes assessment, was used for non-randomized controlled trials . The Cochrane risk of bias tool which evaluates random sequence generation, allocation concealment, blinding, and attrition was used for evaluation of RCTs.

    What Are The Risk Factors For Leaking Urine

    Each type of incontinence can happen for different reasons, but there are some universal factors that can make incontinence more likely. According to MedlinePlus, adults are more likely to develop urinary incontinence if they:

    Having a birth defect that affects the structure of your urinary tract can also raise your risk. Your risk is also higher if a close family member has urinary incontinence, especially urge incontinence, per the Mayo Clinic.

    Many times, people with no risk factors can experience urinary incontinence. “Almost 70% of urge incontinence is idiopathic, meaning we don’t know what causes it to happen in otherwise perfectly healthy people,” says Dr. Sheyn.

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    What Are The Symptoms Of Urinary Incontinence

    The following are common symptoms of urinary incontinence. However, each individual may experience symptoms differently. Symptoms may include:

    • Needing to rush to the restroom and/or losing urine if you do not get to the restroom in time

    • Urine leakage with movements or exercise

    • Leakage of urine that prevents activities

    • Urine leakage with coughing, sneezing or laughing

    • Leakage of urine that began or continued after surgery

    • Leakage of urine that causes embarrassment

    • Constant feeling of wetness without sensation of urine leakage

    • Feeling of incomplete bladder emptying

    The symptoms of urinary incontinence may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

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    Should I Drink Less Water Or Other Fluids If I Have Urinary Incontinence

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    No. Many people with urinary incontinence think they need to drink less to reduce how much urine leaks out. But you need fluids, especially water, for good health.

    Women need 91 ounces of fluids a day from food and drinks.11 Getting enough fluids helps keep your kidneys and bladder healthy, prevents urinary tract infections, and prevents constipation, which may make urinary incontinence worse.

    After age 60, people are less likely to get enough water, putting them at risk for dehydration and conditions that make urinary incontinence worse.12

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    Control Your Urge To Urinate

    You may be able to control, or suppress, the strong urge to urinate, which is called urge or urgency suppression. With this type of bladder training, you can worry less about finding a bathroom in a hurry. Some people distract themselves to take their minds off needing to urinate. Other people find that long, relaxing breaths or holding still can help. Doing pelvic floor exercises to strengthen your pelvic floor also can help control the urge to urinate. Quick, strong squeezes of the pelvic floor muscles can help suppress urgency when it occurs, which may help you get to the toilet before you leak.

    What Is The Treatment For Urinary Incontinence

    Specific treatment for urinary incontinence will be determined by your doctor based on:

    • Your age, overall health and medical history

    • Type of incontinence and extent of the disease

    • Your tolerance for specific medications, procedures or therapies

    • Expectations for the course of the disease

    • Your opinion or preference

    Treatment may include:

    • Behavioral therapies:

    • Bladder training: Teaches people to resist the urge to void and gradually expand the intervals between voiding.

    • Toileting assistance: Uses routine or scheduled toileting, habit training schedules and prompted voiding to empty the bladder regularly to prevent leaking.

  • Diet modifications: Eliminating bladder irritants, such as caffeine, alcohol and citrus fruits.

  • Pelvic muscle rehabilitation :

  • Kegel exercises: Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence.

  • Biofeedback: Used with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.

  • Vaginal weight training: Small weights are held within the vagina by tightening the vaginal muscles.

  • Pelvic floor electrical stimulation: Mild electrical pulses stimulate muscle contractions.

  • Medication :

  • Pessary

  • Office procedure

  • Slings

  • Bladder suspension

  • Consult your doctor with questions regarding the management and treatment of urinary incontinence.

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