Understanding Bladder and Bowel Control

Tonight we’re going to talk about bowel and bladder control primarily, so Dr. Graves and I both actually trained together at the University of Pennsylvania in Philadelphia. And we’ve been each practicing for close to ten years and we’ve had five years of urology training in residency and med school before that. And the topic tonight is something that we do have a lot of focus in and enjoy taking care of and have specialty in. 

So really we’re going to be dealing with two main things: that’s problems with number one and number two, so issues with urinary control and bowel control today. And actually I still remember one of the main reasons I went into urology was because I wanted to help people with quality of life issues. And often having issues controlling either urination or your bowels can be embarrassing and difficult to talk about. And a lot of patients I’ll even deal with for other reasons and they just don’t want to talk about it because they’re just embarrassed. But it’s very common and as patients even young patients can have issues but as we get older they can become more prevalent, but we want to create awareness about it and let you know that you can talk to your physicians, doctors and urologists about it and there are solutions and it’s not something you have to live with. 

So just a quick outline of what we want to talk about today is understanding the bladder and bowel control better today, the care pathway for these different treatment options. And then we can also talk about how medtronic has different treatment options such as inner stem, another type of treatment called neuro, and we’ll discuss those in detail and then we’ll open it up for some questions. So if you’re having bowel and bladder issues you’re not alone, it’s very common and one in six adults can have an overactive bladder. And we’ll discuss what that means so OAB is often referred to as overactive bladder. 

So you have about 37 million Americans who have an overactive bladder and that’s where you have urinary frequency, urgency, difficulty with controlling urination when you want to, and that can even have incontinence where you actually can have urinary incontinence and lose control of your urine. And then one in 12 adults can have fecal incontinence and that’s loss of control of having a bowel movement so that can be very distressing for patients. And this is quite common just to compare there’s 12 million patients in the U.S with vision problems and 17 million patients with asthma so it’s even more prevalent than that.

Why Do I Pee So Much

Key takeaways

  • The frequency of peeing can be used to monitor overall health and anticipate certain problems. A regular peeing rate and volume occur when a person is well-hydrated and there is no undue pressure on the pelvic floor, bladder, and kidneys. A normal range is 5-8 voids in 24 hours and no more than twice at night if over 60 years old.
  • Nocturia, or frequently peeing at night, can be caused by decreased production of anti-diuretic hormone (ADH) with age or a lack of production in children. It can also be caused by drinking too much water, taking diuretic medications, untreated diabetes, urinary tract infections, or an overactive bladder.
  • It is important to speak with a medical professional if experiencing frequent or urgent peeing as it can be a symptom of underlying health issues.

Peeing can be an inconvenience when it gets more frequent and urgent.

The good news is that you can use your frequency of peeing to monitor how your body works. You can use it to assess your overall health and anticipate certain problems.

What is considered normal when it comes to peeing?

A regular peeing rate and volume occur when you are well-hydrated. There is no undue pressure on your pelvic floor, bladder, and kidneys. It means that you can anticipate when and how frequently you visit the bathroom.

When healthy, a good peeing range is 5-8 voids in 24 hours. At night, you shouldn’t wake up more than twice to pee if you are over 60 years old. When you pee more than eight times in 24 hours, that could mean that you have an overactive bladder.

The amount of urine you pass depends on how much fluid you drink, how big your bladder is, and how much urine your body produces.

Your body makes roughly 3 liters of urine each day. If you have a normal, healthy bladder,  you can hold 300-400 ml of urine (approximately 2 cups). The urge to pee should generally start when your bladder has 150ml of urine (just over half a cup).

What is nocturia?

Peeing frequently at night is called nocturia. It means you have to wake up more than once a night to go to the bathroom.

The body usually produces more anti-diuretic hormone (ADH) at night, which prevents your kidneys from filtering and releasing water until you wake up. With normal ADH, you shouldn’t have to struggle to hold urine through your sleep.

However, ADH production decreases with age. That is why older adults are at higher risk of nocturia than younger adults.

ADH takes more time to be produced in children. That is why children below six years tend to wear diapers at night because they can’t hold pee overnight.

What causes peeing too much?

  1. Drinking too much water

The more fluid you drink, the more urine you make, and the more frequently you need to pee. You can tell if you are drinking enough by checking the color of your urine. If your pee is light yellow to clear, then you’re taking in enough fluid.

But if your pee is always clear and you spend a lot longer in the bathroom, then you are probably drinking too much. Though drinking too much fluid isn’t dangerous, you can ease the amount to reduce your visits to the toilet.

  1. Accidental or therapeutic use of diuretics

Diuretic medications help your body to get rid of excess fluid. The drugs work by prompting the kidney to be more permeable to sodium. This allows more sodium in the urine, which draws more water out of the blood into urine, lowering your blood pressure.

Diuretics are used as medications for high blood pressure. You should expect to pass urine a lot more when on these medications.

Drinks such as coffee, tea, and soda can act as diuretics, increasing your peeing frequency.

  1. Untreated diabetes

Untreated diabetes means a continually high level of glucose in your blood. Since your kidneys can’t handle the re-absorption of this extra glucose, it is excreted in the urine.

The presence of glucose in your urine draws additional fluids along with the glucose, resulting in an increased peeing rate. And as you lose more fluids, your body becomes dehydrated, and you feel thirstier than usual. You will end up drinking and peeing a lot more.

  1. Urinary tract infections

Urinary tract infections occur when bacteria enter via the urethra and multiply anywhere in your urinary tract. As the bacteria multiply, usually in the bladder, inflammation, and irritation increase the urge to pee.

In some cases, the bladder can become inflamed without an infection. This type of inflammation results in a chronic condition called interstitial cystitis or painful bladder syndrome, which is more common in women.

  1. Overactive bladder

Characterized by a sudden urge to pee that you can’t control, an overactive bladder occurs when signals from the brain fail, causing bladder muscles to want to squeeze out urine when it isn’t full.

This condition is an urge-related form of urinary incontinence, wherein suddenly you feel the need to pee, but not much comes out.

Overactive bladder is more common in people with neurological disorders, such as multiple sclerosis, stroke, Parkinson’s disease, dementia, or a bladder abnormality like bladder tumor.

These diseases tend to cause damage to the nerves that tell the bladder muscles when to contract.

  1. Urinary incontinence

Urinary incontinence is a condition where muscles that close off the urethra become weak, causing stress-inducing urinary leakage. The leaks may occur when you’re sneezing, coughing, or during strenuous exercise.

Incontinence may be due to pregnancy and childbirth, which weaken pelvic floor muscles.

Additionally, lower estrogen levels after menopause can also cause tissues to deteriorate in the urinary tract, resulting in incontinence.

  1. An enlarged prostate

For men with an enlarged prostate, there may be a constant feeling of needing to pee.

The growing prostate puts pressure on the urethra. It blocks the flow of urine, making the bladder work harder to expel the urine. The leftover urine can become a breeding ground for bacteria and lead to inflammation, further messing with the bladder.

  1. Pregnancy

When pregnant, blood volume increases, and the kidneys have to work through the excess fluid. This means that more fluid ends up in the bladder, and you can pee too much.

Increased frequency of peeing starts in the first trimester and gets worse in the subsequent trimesters.

What are the solutions to frequent peeing?

Frequent peeing can be reduced by cutting out bladder irritants from the diet. You can do so by avoiding alcohol, caffeine, artificial sweeteners, citrus, and spicy foods.

You should also quit smoking and lose weight. And drink most of your fluids earlier in the day to avoid trouble at night.

Peeing too much can be treated using medications. You can take medications that relax the bladder and its nearby muscles, such as antidepressants imipramine (Tofranil) and duloxetine (Cymbalta).

You can also get a Botox injection into your bladder. This will give temporary relief by paralyzing the muscles and blocking the chemical messenger acetylcholine, which sends signals to your brain to trigger abnormal bladder contractions associated with an overactive bladder.

Anti-cholinergic drugs, such as Oxybutynin, also block acetylcholine.

Pelvic floor physiotherapy is also ideal for stress-related incontinence, like pregnancy-linked incontinence.

But when incontinence occurs after menopause, estrogen creams may help by restoring the tissues near the urinary tract.

Bladder training is effective in controlling frequent peeing. It involves trying to go longer and longer without peeing over time.

For instance, if you go every hour, you can extend that time by 10 minutes for some days. Then keep adding on 10 minutes until you find yourself holding your pee for a longer period.

Safe, effective treatment of urinary incontinence

If you are peeing too much, you should see a urologist to determine the cause and degree of incontinence you have.

At St Pete Urology, we’ve helped many patients recover from leaky bladders through our tailored treatments.

Our solutions include behavioral therapies, pelvic muscle rehabilitation, incontinence devices, medication, Botox injections, and surgery. Our doctors have vast experience in diagnosing urinary incontinence and in providing the most appropriate treatments.

References

9 Tips to Keep Your Bladder Healthy

The bladder’s function is to store urine and allow urination to be infrequent and controlled. Bladder problems may lead to bothersome issues such as incontinence, infections and overactive bladder. While you may not be able to prevent every possible bladder problem, taking appropriate measures can help to lessen many of them.

What should you do to keep your bladder healthy?

1. Drink plenty of fluid

Drinking plenty of fluid increases the volume and frequency of urination, which in turn helps to flush out bacteria from your bladder. Water is the best fluid for your bladder and should be at least half of your daily fluid intake.

Ideally, you should drink 6-8 eight-ounce glasses of water every day. But if you engage in intense exercise or activity, you may need to drink more to compensate for fluid loss. On the other hand, if you have a condition such as heart disease or kidney failure, you may need to drink less. Speak with your doctor about how much fluid is right for you.

2. Avoid smoking

Smokers are more likely to develop bladder control issues than non-smokers. Cigarette smokers also tend to have more severe bladder symptoms. For heavy smokers, there is a tendency to develop a chronic cough, which exerts added pressure on the bladder and worsens urinary incontinence. Plus, tobacco smokers are three times more prone to bladder cancer than non-smokers. Avoiding cigarette smoking is good for your bladder health.

3. Get active

Physical activity not only relieves bladder problems but also prevents fluid buildup in the legs. Fluid retention in the legs—usually due to heart disease or a sedentary lifestyle—can lead to bladder control issues. You can reduce fluid retention through low-impact moderate activity such as biking, swimming or walking briskly for at least 30 minutes at least 5 days a week.

4. Do Kegel exercises

Weak pelvic floor muscles are a common cause of urine leakage (incontinence). Kegel exercises target and strengthen pelvic floor muscles and keep urine from leaking when you sneeze, laugh, lift or have a sudden urge to urinate. Speak with your urologist about what kind of exercise will benefit you the most.

5. Avoid bladder irritants

Certain foods and beverages can irritate the bladder and trigger bladder problems. Known bladder irritants include alcoholic beverages, apples, apple juice, bananas, brewer’s yeast and carbonated drinks. Others are chilies, chocolate, citrus fruits, coffee, cranberries, grapes, nuts, raw onions, raisins, soy sauce, tomatoes and vinegar.

While you don’t have to stop eating your favorite foods and drinks entirely, reducing the amounts can improve your bladder symptoms.

6. Maintain a healthy weight

Being overweight is a risk factor for incontinence, particularly stress incontinence. The excess weight exerts more pressure on the abdomen and bladder and weakens pelvic floor muscles. In fact, nearly 50-percent of older people who are overweight struggle with bladder incontinence.
By losing weight in the abdominal area, you can reduce pressure on the bladder and pelvic muscles and improve bladder control. In many cases, weight loss improves incontinence symptoms or gets rid of them completely. Make healthy food choices and engage in regular exercise to achieve and maintain a healthy weight.

7. Prevent constipation

Bladder problems are quite common in people with constipation because a full rectum presses the bladder wall causing either outflow obstruction or increased spasm. Also, constipation makes pelvic muscles overactive, which causes dysfunction in stool and urine elimination and leads to an overactive bladder. You can reduce constipation by drinking enough water, eating high-fiber foods (like whole grains, fruits, and fresh vegetables), and being physically active.

8. Manage medications

Some medications can trigger bladder control problems. For example, high blood pressure prescriptions tend to increase urine output and relax bladder muscles resulting in urine leakage. Drugs such as antidepressants, muscle relaxants, antihistamines, sedatives, and tranquilizers may hinder bladder contraction and reduce awareness of the need to urinate.

You should not stop taking your medications just because you suspect they are responsible for your bladder issues. Instead, and before making any change, speak with your doctor about your concerns. The doctor may adjust the dosage or offer a different medication. In cases where the benefits of the medications far outweigh the related bladder issues, your doctor will work with you on alternative ways to ease symptoms.

9. Flush out bacteria

Proper cleaning of the genital area before and after sexual intercourse helps to reduce bacteria and prevents bladder infections. Passing urine before and after sex helps to flush out bacteria and stops their entry into the urethra during sex.

Since holding urine in the bladder for too long increases the risk of infection and can weaken bladder muscles, make sure to pass urine as often as possible. Use the bathroom at least every 3 to 4 hours, and when urinating, don’t rush. Take your time to fully empty your bladder.

At St Pete Urology, we provide expertise in the diagnosis and treatment of urinary disorders. Our urology specialists will work with you to develop an individualized treatment plan for your problems. We value our multidisciplinary and compassionate approach to caring for our patients. For more information on the prevention, diagnosis and treatment of urinary disorders, visit the St Pete Urology website.

Facts About Stress Urinary Incontinence in Women

What Is Urinary Incontinence?

Many women have a silent concern due to urinary incontinence. It somehow seems taboo to talk about the problem, even with a regular doctor or gynecologist. There are approximately 25 million Americans who suffer from some type of urinary incontinence and as many as 80 percent of them are women. Pregnancy, giving birth, going through menopause and even the unique structure of the female urinary anatomy contribute to the disparity between male and female sufferers.

Urinary incontinence is defined as the unintentional loss or leakage of urine. The term “stress incontinence” means that when the body is under exertion it puts pressure on your bladder and the bladder leaks. Some triggers for stress incontinence include running, coughing, sneezing, bending or heavy lifting.

Bladder Retraining

The bladder is controlled by muscles and it can be trained. You may wish to keep a voiding diary, noting things like times of urination, duration between bathroom trips, types of food or beverages that seem to trigger urgency or frequency of bathroom trips. This journal describing your symptoms and potential causes can help if you need to visit a urologist for treatment.

As you establish baselines for your urinary problem, you can start behavior modification and training your bladder. Here’s how to do it:

  • Schedule Your Bathroom Breaks

Start by scheduling bathroom visits. Increase the time periods between those breaks by adding 15-minute increments. Visit the bathroom even if you don’t feel you need to go. You will be working toward longer and longer stretches of time between breaks.

  • Perform Kegel Exercises

When you learn to isolate the muscles that control urine flow, you can practice having more control by performing Kegel exercises while sitting, standing or during urination.

Other Tips to Prevent Overactive Bladder:

  • In addition to bladder retraining, you may want to eliminate or limit beverages that increase the need for urinating, like coffee, tea or caffeinated sodas.
  • Drink fewer fluids before bedtime.

Treating Overactive Bladder With Behavioral Modifications

You needn’t feel alone when you have urinary incontinence. Make an appointment with a urologist who is trained to deal with your condition. Your doctor may take any of the following approaches beyond what you can do on your own:

  • Recommend biofeedback,
  • Send urine or drawn blood to the lab to determine how completely you empty your bladder.
  • Prescribe medicine to address bladder function or tighten muscles.
  • Employ a medical device, such as a urethral insert or a pessary.
  • Try nerve stimulation, using a mild electric current to nerves in the bladder that help control urination.
  • Suggest surgery if indicated.

If you have stress incontinence, you may be limiting yourself from fully participating in life events. Seek treatment from experts like those at St Pete Urology, where surgeons perform hundreds of successful sling surgery procedures every year. For more information, visit the St Pete Urology website.

What to Know About Overactive Bladder

Like the name suggests, an overactive bladder is a bladder that does more than it should. The normal functioning of a bladder is that as urine drains from the kidneys to fill the bladder, nerve signals in the brain communicate the need to discharge the urine. The urge to urinate grows gradually so a person can delay the passage of urine for a while. During the discharge of urine, the bladder contracts, letting out the urine through the urethra.

An overactive bladder contracts suddenly and involuntarily, so a patient cannot hold the urine. It also contracts often, even when it contains just a little urine. This forces the patient to take numerous bathroom breaks. Due to the frequency and suddenness of the contractions, an overactive bladder is known to cause the leaking of urine, otherwise known as urine incontinence. It affects both men and women.

Causes of an Overactive Bladder

An overactive bladder cannot be attributed to one single cause or factor. In most cases, it is caused by a combination of factors. These include:

1. Serious case of a urinary tract infection;

2. A neurological disorder that damages the communication of nerves in the brain and in the bladder;

3. Bladder complications such as bladder stones or tumors;

4. Stroke and multiple sclerosis;

5. Acute urine retention. When urine is retained in the bladder for long, there is no longer space for storage of urine. This may result in an overactive bladder;

6. Pelvic organ prolapse in women and benign prostate hyperplasia in men; and

7. Diabetes.

Social and Emotional Impact of an Overactive Bladder

Patients with an overactive bladder often worry a great deal about stigma. They find the frequent bathroom visits embarrassing and the fear of leaking urine in any social or work environment can be debilitating. These fears affect the normal day to day life of a patient and make it necessary to seek treatment as soon as possible.

Treatment of an Overactive Bladder

A patient can receive treatment in the form of medication, injections and in few cases, minimally invasive surgical procedures. Very often these treatment options are combined with physical therapy and behavioral modifications. Such modifications include:

1. Kegel exercises. These are administered to help strengthen the muscles of the pelvic floor;

2. Exercise aimed at achieving and maintaining a healthy weight;

3. Going on scheduled bathroom visits; and

4. Use of absorbent pads.

An overactive bladder is manageable and treatable. In order to avoid the difficulties that accompany the condition, it is advisable to seek the help of a qualified urologist for a proper diagnosis followed up by efficient treatment. Our team of experts at St. Pete Urology can help with any questions, as well as diagnosis and treatment of an overactive bladder. For more information, visit the St Pete Urology website.

What is Urinary Diversion?

Urinary diversion is a solution to any urological problem that prevents the passage of urine in the ordinary way. It is basically a rerouting of the urinal path through surgery.Ordinarily urine flows from the kidneys to the bladder through the ureter. It is stored in the bladder until the individual lets it out by urinating. The tube that drains urine out of the bladder is called the urethra. Sometimes the bladder can no longer function as a storage for urine or it has to be removed. This is common when a patient has cancer of the bladder or has suffered serious injury to the bladder. Urine flow is rerouted to follow another path out. Sometimes the procedure may be performed to provide temporary relief while in other instances it is permanent.

Types of Urinary Diversions

1. Continent Diversion

A continent urinary diversion is created by making a urine reservoir from parts of the bowel, mostly the small intestine. A surgeon can choose to attach the ureters and the urethra to the new reservoir, placing it in the position of the bladder that has been removed. That reservoir is referred to as a neobladder or a continent urinary diversion. A patient who has a neobladder is able to pass urine the normal way.

The alternative for a neobladder is creating a stoma as an outlet for the reservoir. A patient has to connect a catheter to drain urine from the stoma a number of times a day. This form of reservoir is also referred to as a continent catheterizable diversion.

2. Incontinent or Non-continent Diversion

An incontinent diversion connects the ureters that drain urine out of the kidney into an opening of the abdominal wall. The patient then is required to wear an ostomy bag into which the ureters drain the urine.

Performing a urinary diversion is a precise procedure and its complexity depends on the reasons why it is performed. A patient requires strict medical attention both before and after undergoing the procedure. Even after one has recovered, the advice of a urologist is necessary in the management of the various forms of diversions. A patient should insist on receiving the attention of a specially trained urologist if they require a urinary diversion. St. Pete Urology over the years has developed an outstanding staff of specialists in the area and it is a good place to start. For more information, visit the St Pete Urology website.

What is the best treatment for urinary incontinence?

The sling procedure is the best, safest and most effective surgical operation for treating urinary stress incontinence. During the procedure, the urologist creates a sling using an artificial mesh, animal tissue or human tissue and places it under the urethra to support the urethra and bladder neck and to prevent unintentional urine loss.

What is stress incontinence?

Unintentional urine leakage (loss) occurs when you engage in physical activities or movements, such as running, sneezing, heavy-lifting, coughing or any action that puts stress (pressure) on your bladder. The condition is triggered by the weakening of pelvic floor muscles (the muscles supporting your bladder) and urinary sphincter muscles (muscles that control the release of urine).

Normally, as the bladder fills with urine and expands, the valve-like muscles in the urethra remain closed to prevent leakage of urine until you have reached the bathroom. However, if those muscles weaken and are not able to withstand pressure, then anything that exerts pressure on your pelvic and abdominal muscles can cause unintentional loss of urine.

Your sphincter and pelvic floor muscles may weaken because of:

  1. Type of childbirth/delivery.
  2. Previous pelvic or abdominal muscle surgery.
  3. Obesity/increased body weight.
  4. Smoking, which may trigger frequent coughing.
  5. Prolonged involvement in high-impact activities, such as running and jumping for several years.
  6. Age — the muscles weaken with increasing age.

You have stress urinary incontinence if you frequently leak urine when you:

  1. Sneeze
  2. Cough
  3. Stand up
  4. Laugh
  5. Have sex
  6. Get out of your car
  7. Exercise
  8. Lift something heavy

While stress incontinence does not imply that you will lose urine every time you do these things, you will most likely experience frequent leakage of urine when you engage in pressure-increasing activities.

Why should you undergo the sling procedure for stress urinary incontinence?

Having stress incontinence can be really awkward and embarrassing. In fact, with frequent leakage of urine, you may begin isolating yourself and limiting your social and work life. For instance, you may find it difficult to engage in exercise and in different leisure activities for fear of urine leakage. But with treatment, you can manage the incontinence and improve your overall quality of life and well-being. The sling procedure is ideal for you if you’ve tried other measures and still find urine leakage disruptive to your life.

How does the sling procedure work?

The sling procedure is aimed at closing your urethra and the neck of your bladder. For the procedure, your surgeon uses strips of synthetic mesh, animal tissue, donor tissue or your own tissue to develop a sling (hammock) that is inserted under your urethra or bladder neck. Once the sling is placed, it supports the urethra and ensures it remains closed — particularly when you are engaged in pressure-increasing activities such as coughing, laughing, sneezing or exercise — preventing the leakage of urine.

How is the sling procedure performed?

Before the procedure begins, you are placed under either general or spinal anesthesia. With general anesthesia, you will remain asleep throughout the procedure and will feel no pain. With spinal anesthesia, you are completely awake except that the area of your body from the waist down is numb and you don’t feel pain as the procedure is performed. Following application of anesthesia, the urologist places a tube (catheter) into your bladder to drain any urine already inside it.

The surgeon then proceeds to place the sling in any of the following ways:

1. Retropubic Method (Tension-Free Vaginal Tape/TVT Method): The surgeon makes a tiny incision inside your vagina, just under the urethra. Two other cuts are then made above your pubic bone — large enough to allow needles through. The surgeon uses a needle to place the sling beneath the urethra and behind the pubic bone. Using stitches or skin glue that is easily absorbed by the body, the surgeon closes off the cuts.

2. Single-Incision Mini Method: The surgeon makes a single tiny incision in the vagina, then passes the sling through it. No stitches are used to attach the sling, but over time the scar tissue grows and forms around it, keeping it in place.

3. Transobturator Method: The surgeon makes a tiny cut inside the vagina, just under the urethra. Two more cuts are made, one on each side of the labia (folds of skin on either side of the vagina). Using the incisions, the surgeon inserts the sling under the urethra.

At St Pete Urology, we perform hundreds of sling surgery procedures every year with remarkable results for our patients. The sling procedure is an outpatient operation that takes about one hour to complete and the patient is free to go home the same day. After the procedure, we arrange for follow-up sessions with our patients in the doctor’s office to assess the efficacy of the procedure and help with any complications that may arise. So if you are feeling embarrassed by stress urinary incontinence or have tried other measures without success, check with us to find out if the sling procedure can help you overcome the condition. For more information, visit the “St Pete Urology” site.

4 Effective Treatments for Urinary Incontinence in Men

There is no single treatment for urinary incontinence that works for all men. The treatment that your urologist recommends will depend on the type of urinary incontinence you are having and the severity of the symptoms on your life. At St Pete Urology in St Petersburg, Fl, urologists may even consider your lifestyle and your treatment preferences, beginning with the simpler treatment options before going for the complex ones.

In fact, many men usually regain urinary control after changing a few of their habits and engaging in exercises to strengthen their bladder muscles. But if the behavioral treatments fail to yield desirable results, the urologist may choose to apply a continence device or prescribe medications. In some men, surgery is the right treatment for their urinary incontinence.

If there is no cancer, infection or other underlying cause of urinary incontinence that can only be cured by surgery, the urologist will complete the treatment in stages, starting with behavioral changes and performing surgery only as a last resort. Here are the 4 treatments that are effective for urinary incontinence in men.

1. Behavioral treatments

For some men, treatment of urinary incontinence is as simple as planning for regular bathroom trips or limiting fluid intake to certain times of the day. This type of therapy for UI is called bladder training or timed voiding. So at St Pete Urology in St Petersburg, Fl, the urologist may recommend some changes in your urinary habits, diet or lifestyle to help you gain control over your bladder. As you regain control, you will be able to extend the time you take between bathroom trips. Bladder training (timed voiding) also includes Kegel exercises for strengthening pelvic muscles to enable the bladder to hold urine longer.

2. Medicines

Urologists prescribe medicines that can help to improve bladder control in men with urinary incontinence. The medicines work in different ways, with some blocking abnormal nerve signals sent at the wrong time while others slow down urine production. Still other medications help relax bladder muscles or shrink an enlarged prostate. The most common drugs used for urinary incontinence in men include:

(a) Alpha-blockers: Drugs such as Doxazosin (Cardura), Terazosin (Hytrin), Alfzosin (Uroxatral) and Tamsulosin (Flomax) are used to relieve urinary incontinence caused by bladder outlet obstruction and prostate enlargement. These drugs relax the smooth muscles of the bladder neck and prostate, encouraging the normal flow of urine and preventing abnormal contractions of the bladder, which may cause incontinence.

(b) Imipramine: The drug Tofranil, which belongs to the tricyclic antidepressants class, works by relaxing muscles and blocking nerve signals that might lead to bladder spasms. This helps to relieve urinary incontinence in men.

(c) Antispasmodics: Drugs such as tolterodine (Detrol LA), trospium chloride (Sanctura), solifenacin succinate (VESIcare), darifenacin (Enablex), oxybutynin (Ditropan XL) and Finasteride (Proscar) work by relaxing bladder muscles and relieving muscle spasms, which in turn helps to relieve urinary incontinence.

(d) 5-alpha reductase inhibitors: Drugs such as dutasteride (Avodart) and finasteride (Proscar) inhibit the production of DHT, a male hormone believed to be responsible for prostatic enlargement. When administered, the 5-alpha reductase inhibitors relieve urinary incontinence through the shrinking of an enlarged prostate.

3. Self-catheterization

Urologists at St Pete Urology in St. Petersburg may recommend self-catheterization for men having overflow incontinence due to a weak bladder or a blockage. The catheter (a thin, hollow tube) is inserted through the urethra to reach the bladder and help drain the bladder in men having urinary incontinence. In some cases, urologists may recommend self-catheterization when their evaluations have established that surgery is not ideal for their patients.

4. Surgical treatments

If you are suffering from urinary incontinence because of a nerve-damaging event, such as radical prostatectomy or spinal cord injury, then surgery is the best treatment for the condition. The surgery performed may be a urinary diversion, male sling or artificial sphincter.

(a) Urinary diversion surgery: If all the bladder function has been lost or the bladder must be removed after nerve damage, the urologist may consider an operation to create a urinary diversion. During this procedure, the surgeon will create a reservoir by removing a small piece of your small intestine and then redirecting the ureters to the reservoir. A stoma (an opening in the lower abdomen that is used to drain urine into a bag or through a catheter) also may be created by the surgeon.

(b) Male sling surgery: In the sling procedure, the surgeon boosts the support for the urethra by wrapping it with a strip of material and then attaching the ends of the strip to your pelvic bone. The sling will ensure there is constant pressure on the urethra and that the urethra does not open unless the patient consciously decides to release the urine.

(c) Artificial sphincter surgery: At other times, the urologist may decide to implant a device (artificial sphincter) that can keep the urethra closed until the patient reaches the bathroom and is ready to pass urine. This operation helps men with urinary incontinence due to weak sphincter muscles or nerve damage that has impaired the functioning of the sphincter muscle.

At St Pete Urology in St Petersburg, Fl, we know that urinary incontinence in men is an underreported and under-diagnosed problem, as many patients are too embarrassed to seek treatment. We apply a personalized, friendly, compassionate and multidisciplinary approach in the screening, diagnosis and treatment of urological problems. This approach ensures that all types of urinary incontinence are correctly diagnosed and treated promptly. If you suspect that you or your loved one is suffering from urinary incontinence, visit St Pete Urology for effective treatment. For more information on urological disorders, visit the “St Pete Urology” site.

Causes of Urinary Incontinence in Men

Urinary incontinence in men is the unintentional or accidental loss of urine. In the United States, up to 17 percent of men may suffer from urinary incontinence, with the frequency of the condition increasing with age. Urinary incontinence is not a disease but just the symptom of an underlying condition, such as a prostate problem, injury to the urinary tract or a disease of the nerve system.

There are three major types of urinary incontinence in men:

  1. Stress incontinence: It is the leakage of urine that occurs when the pressure inside the bladder increases when doing things such as sneezing, coughing, climbing or lifting.
  2. Urge incontinence: This is the accidental loss of urine that occurs when the need to urinate is too strong and uncontrollable.
  3. Overflow incontinence: This is the unintentional loss of urine characterized by dribbling or leakage of urine in small quantities. It can happen even when you do not feel the urge to urinate.

Causes of Urinary Incontinence in Men

There is no standout factor among the causes of urinary incontinence in men. However, prostate gland problems and their treatment are often the most common causes of UI in older men. The prostate, which is normally the size of an almond, is found at the opening of the bladder. The principal role of the prostate is adding fluid to the semen during ejaculation. The problem with the prostate gland is that it tends to increase in size as a man grows older and extend to the point of impeding or slowing down the flow of urine from the bladder.

Other common causes of male urinary incontinence are muscle and nerve control problems. At the opening of the bladder is a muscle called the urinary sphincter, which controls the opening and closing of the bladder. Anything that affects the muscle or nerve function of the sphincter can result in urinary incontinence. The common underlying factors in urinary incontinence include:

  1. Benign Prostatic Hyperplasia (BPH): Most men experience prostatic enlargement after the age of 40. As the prostate grows bigger, it compresses the urethra and may impede the flow of urine, resulting in urinary incontinence.
  2. Prostate surgery: The surgical removal of the prostate gland during the treatment of prostate cancer or BPH can damage or weaken the muscles controlling urine flow, resulting in stress urinary incontinence.
  3. Urinary tract infections: The infections can cause an overactive bladder, which may be characterized by urinary incontinence
  4. Diabetes: Diabetes can cause damage to the nerves or muscles controlling how the bladder opens and closes. It also can cause frequent urination or an overactive bladder. Obesity, which is quite common in type II diabetes, can make urinary incontinence worse by exerting more pressure on the bladder.
  5. Stroke: Stroke refers to brain damage that is caused by decreased flow of blood to the brain because of a clot or a leaking blood vessel. When stroke occurs there may be loss of muscle control and decreased sensation, which may lead to urinary incontinence. Stroke also can make it difficult for a man to get up and walk to the bathroom, which also contributes to urinary incontinence.
  6. Neurological diseases: The two most common neurological diseases that may cause urinary incontinence are Parkinson’s disease and multiple sclerosis. The conditions make it difficult for nerve signals to be sent and received between the central nervous system(CNS) and the bladder, increasing the risk of urinary incontinence.
  7. Spinal injury: Nerve impulses transmitted between the brain and bladder usually come through the spine. Therefore, any severe injury to the spine can lead to urinary incontinence.
  8. Temporary causes of urinary incontinence: Temporary episodes of urinary incontinence may be caused by drinking too much alcohol or caffeine, constipation, or depression. Medications such as diuretics for treating high blood pressure, medications for depression and over-the-counter medications containing decongestants or antihistamines also can cause urinary incontinence.

When to see a doctor

If you experience urinary incontinence symptoms such as inability to control the urge to urinate, overflowing, or leaking urine under stress, then you need to talk to a urologist. At St Pete Urology, St Petersburg, Fl, we encourage men not to feel embarrassed by the symptoms of urinary incontinence and wait too long before seeing a doctor because the condition can get worse. We have established a multi-disciplinary and compassionate, patient-centric approach to treating urological disorders in order to encourage all men with the symptoms of UI to seek prompt treatment. So, if you are experiencing any UI symptoms, visit St Pete Urology as soon as you can because seeing a urologist early increases the likelihood that you will get an effective treatment that will help you find relief. For more information, visit the “St Pete Urology” site.

What is Urinary Incontinence in Men?

What is Urinary Incontinence in MenAccidental or unintentional leakage of urine is called urinary incontinence (UI). While urinary incontinence in men is not a disease, it is usually a symptom of an underlying urinary tract problem, such as overactive bladder muscles, damaged or weak bladder muscles, nerve damage, and certain prostate conditions. In men, urinary incontinence can occur at any age, with young boys being slower than girls in developing bladder control and being more likely than girls to experience bedwetting (nocturnal enuresis). However, due to anatomical differences, adult men are less likely to experience urinary incontinence than adult women. In adult men, the prevalence of urinary incontinence increases with age, though UI is not an inevitable part of aging in men.Reasons for the occurrence of urinary incontinence in men

Urinary incontinence can happen when:

  1. The bladder muscles squeeze at the wrong time or if they squeeze too hard.
  2. The muscles around the urethra are either weak or damaged, allowing urine leakage even when you do not have a problem with your bladder squeezing at the wrong times.
  3. You frequently experience incomplete emptying of the bladder when you void, increasing the volume of urine in the bladder significantly and resulting in loss of urine when the bladder gets too full.
  4. There is a blockage of the urethra which causes urine build-up in the bladder and results in eventual leakage.

Types of urinary incontinence in men

Urinary incontinence can be either a short-term problem or a long-term issue. Short-term urinary incontinence in men is usually caused by an underlying health problem or an ongoing treatment while long-term (chronic) incontinence may be caused by a wide range of physiological problems. The types of urinary incontinence in men include:

  1. Stress incontinence: Leakage of urine when a man sneezes, coughs, laughs, lifts something, changes position, or performs an activity that strains or puts stress on his bladder.
  2. Urge incontinence: It is an urge to urinate that is usually so strong that a man can’t make it to the toilet in time. This type of urinary incontinence can happen when the bladder squeezes at the wrong time, resulting in loss of urine even when the bladder has only a small quantity of urine. Overactive bladder is a common example of urinary incontinence, though not all men with overactive bladder will experience leakage of urine.
  3. Overflow incontinence: Occurs when a man has the urge to urinate but can only release a small amount of urine at a time. Since the bladder does not empty fully as it should, the urine remaining in the bladder leaks at a later time.
  4. Functional incontinence: Occurs when a man cannot make it to the bathroom in time either because he is not able to walk on his own or because something prevents him from reaching the bathroom promptly.
  5. Total incontinence: When a man’s sphincter muscles can no longer work, urine will always leak and the man will have no control on when to urinate. This is called total incontinence.

Causes of urinary incontinence in men

Different types of urine incontinence have different causes.

  1. Stress incontinence: Can occur after the prostate gland is removed or when there is damage to the nerves or the sphincter, which reduces the support afforded to the lower part of the bladder.
  2. Urge incontinence: Occurs when bladder muscles squeeze extremely hard and make it difficult for the sphincter to hold back urine. As a result of hard squeezing, a man will experience a very strong urge to urinate.
  3. Overflow incontinence: Can occur when something blocks the urethra, resulting in the build-up of urine in the bladder. Overflow incontinence may be caused by enlarged prostate, prostate cancer, a narrow urethra, or weakened bladder muscles.

In men, urinary incontinence is usually related to prostate problems and various treatments. Nevertheless, excessive drinking of alcohol may make incontinence worse while over-the-counter or prescription drugs such as antidepressants, sedatives, diuretics, narcotics and sedatives can affect the type of symptoms experienced.

Diagnosis and treatment

The diagnosis of urinary incontinence involves a medical history and a physical examination, but also may include keeping a bladder diary. Your urologist will examine you physically and ask some questions about your past health and current symptoms before ordering any tests. Usually these steps will enable your urologist to determine the cause of your urinary incontinence. But at other times, particularly when your symptoms have more than one cause or have an unclear cause, the urologist may include urodynamic testing and an ultrasound in order to come up with a more accurate diagnosis.

The treatment offered will depend on the type of incontinence and how the condition is affecting your life. Generally, urologists treat urinary incontinence in men using medicines, behavioral treatments (such as Kegel exercises and bladder training), surgery, or a blend of two or more of these therapies. A few men may require surgery to regain their bladder control, but most men do not. Apart from the treatments offered by the urologist, there are a few things that men can do at home to help them regain control over their bladders. Such actions include:

  1. Cutting back on caffeine-containing drinks, such as tea and coffee. Alcohol should be reduced to not more than 1 drink per day while fizzy drinks such as soda pop also should be reduced.
  2. Eating foods highly rich in fiber to prevent constipation.
  3. Keeping a healthy weight.
  4. Stopping cigarette smoking. Talk to your urologist about stop-smoking medicines and programs.
  5. Practicing double voiding whenever you urinate. This means trying to lose as much urine as you can, relaxing for a short while, then going again.
  6. Visiting the bathroom many times per day. It is important to wear clothes that you can remove with ease and make your route to the bathroom as clear and quick as possible.
  7. Engaging in simple pelvic-floor exercises, such as Kegels.
  8. Using a diary to monitor your urinary symptoms and any leakage of urine. This will help you and your urologist choose the best treatment for you.

Are you experiencing symptoms of urinary incontinence? Do not feel embarrassed to inform your urologist about them. Most men with urinary incontinence can be helped or effectively cured. At St Pete Urology located in St Petersburg, Fl., we fix all urinary incontinence issues affecting men. We have done this for many decades and have some of the best technologies and techniques to help men regain control over their bladders. For more information, visit the “St Pete Urology” site.