DIAGNOSING AND TREATMENT OF URINARY INCONTINENCE
How Is Urinary Incontinence Diagnosed? Measurements of your kidney function and tests to reveal an infection are usually done. A kidney X-ray (intravenous pyelogram) or echogram may be necessary to show the presence of kidney damage or blockage of the bladder.
If the cause of incontinence is not immediately clear, a cystometrogram is often used to measure the amount of urine that your bladder can hold and whether the nerves controlling it are functioning well. During the examination, increasing quantities of sterile fluids are put into your bladder and the pressure developed within it is measured. The test, which is completely safe and has little discomfort, determines whether your bladder is contracting (emptying) normally.
How Is Urinary Incontinence Treated? A urinary catheter (plastic tube) allows urine to drain from the bladder into a plastic bag. This treatment may be useful in temporarily relieving a blocked bladder, but it is not the best treatment for urinary incontinence because it can cause infection. Catheters should be reserved for those who cannot otherwise be treated and in whom the risk of urinary infection is outweighed by the need to be kept completely dry. For instance, after major surgery or trauma, or when a bedridden person has pressure sores, urinary incontinence may contaminate wounds or macerate the skin.
If a urinary infection is found, it may be playing a role in urinary incontinence. The infection should be treated with antibiotics or with drugs that decrease the frequency and urge to urinate. Some people becomes incontinent as part of a depressive illness, and treatment with antidepressant medications can show a remarkable improvement. The use of diuretics and sedatives should be evaluated and, whenever possible, decreased or discontinued. Various medications have been developed which may be useful for incontinence associated with frequent urges to urinate suddenly.
Incontinence in men can be controlled by a clamp that closes the penis. This is rather uncomfortable, and one must be mentally alert for it to be applied properly. In most instances it should be avoided. A condomlike sheath that covers the penis and is connected to a bag by plastic tubing is sometimes useful, especially at night. However, this often causes irritation of the penis.
For those people who are partially or completely bedridden, incontinence pads have been specially designed to absorb urine but leave the body relatively dry. For those who are more mobile, there are special undergarments or pads that absorb urine but prevent the skin from becoming wet. Specially designed pads for adults are available; these are similar to disposable diapers and can be worn inside underpants. They can be very useful in the occasionally incontinent person who is mobile at home or in an institution.
Some improvement can follow changes in habits. Women’s symptoms may improve if they lean forward when passing urine. This helps empty the bladder more efficiently. Although the standing position is normal for men, some can pass urine more easily sitting down.
You should try to pass urine frequently. A commode by the bed or a urinal used every few hours may help avoid wetting the bed or undergarments. Whenever possible, you should remain mobile and stay out of bed. If you have severe constipation, you may develop urinary incontinence until your bowel is cleared. The rectum should be examined to be sure that a full bowel is not pressing on your bladder.
Sometimes incontinence results from a neurological disease, particularly brain tumors and in an unusual type of hydrocephalus, occasionally found in the elderly. A neurologist can make these diagnoses. Surgical treatment of the brain disorder in these unusual situations may also improve the incontinence.
For individuals in institutions because of severe debilitation, urinary incontinence is often a serious problem. Frequent visits to the bathroom or to a bedside commode can sometimes be effective in decreasing the problem.
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