Understanding Incontinence Types

The treatment of incontinence relies on making a correct diagnosis of the type of incontinence and then instituting specific therapy for that particular type of incontinence. There may be some overlap in treatment. For example, Kegel exercises play a role in the treatment of all forms of incontinence. I have listed out all the different types below.

CLASSIFICATION of INCONTINENCE and DEFINITIONS

Stress Incontinence:

This is one of the most typical types of incontinence. Basically it occurs when you have a sudden increase in ‘intra-abdominal pressure’. That’s the medical term for what happens you when you laugh, cough or sneeze.

Urgency Incontinence:

Also a common form of incontinence, this is when you have a sudden need to urinate and you can’t help yourself or stop it.

Overflow Incontinence:

When your bladder fills and can’t hold anymore and some ends up leaking out.

Functional Incontinence:

Leaking of the bladder due to mental or physical issue that hinders your ability to realize you need to go to the bathroom and it just comes away (e.g. dementia, spinal cord injury).

Mixed Incontinence:

urine leakage due to any combinations of the above types.


Regards,

Dr. Himel

The Need For Patient Referrals

A number of recent visitors to my blog have asked why they require a physician referral to see me rather than simply telephoning themselves to make their own appointment. The reason is both simple and very important and has to do with continuing care.

Eventually and hopefully under treatment your problem will clear up completely or at least be sufficiently improved that nothing further needs to be done through my office. At this point, I will send your back to the referring doctor for continuing care.

As I do not do continuing care I need to ensure that your family physician is looped into all the various steps along the way. That would usually include a report outlining the diagnosis, the recommended treatment, copies of the questionnaires filled out on the initial visit and repeated after a course of the recommended treatment.

When it comes to most bladder control problems, continuing care is key and again for that reason, I require everyone who comes to see me have a referral from their family doctor. Remember, your care is a partnership and the better the communication between your family doctor and myself is the better your overall care will also be.

Regards,

Dr. Himel

Tips For Kegel Exercises

Kegel exercises have become the lynchpin of the conservative (non-surgical) management of incontinence. Some women have trouble however doing the exercises properly. Here are some tips that might help. If anyone else has some tips feel free to join in the conversation in the comments. If you haven't seen my other post on the importance of Kegel's go here.

Best Regards,

Dr. Himel

Empty the bladder.

Tighten the pelvic floor muscles for a count of 5 to start. Gradually increase the count to 10.

Relax the pelvic floor muscles for a count of 10.

Do the exercises at least 10 times, 3 times a day.

Finding The Right Muscles

1) place a finger in the vagina (the rectum if a male} and squeeze
the finger with your pelvic muscles.

2) try and stop the flow of urine momentarily while voiding.

3) squeeze the muscles that you think will stop the act of
voiding or of passing gas rectally.

Dr. Kegel & The Importance Of Exercise

A number of non-surgical treatment modalities are available for the successful management of incontinence. In 1948, a gynecologist in California suggested that building up the muscles that support the pelvic organs would alleviate many of the troublesome symptoms of incontinence regardless of the type of incontinence the patient was dealing with. This gynecologist was Dr, Arnold Kegel, after whom the exercises he first described are named.

The muscles he was referring to form a hammock across the lower pelvis and support the bladder, the bowel, and the reproductive organs. We know for these organs to function, there must be egress (basically a way out) to the exterior. The tube that connects the bladder to the outside (the urethra) must pass through these muscles. The vagina must do the same thing to allow egress of the contents of the womb (uterus). Finally, the contents of the bowel must have a way to get out as well.


For all these functions to work well, you have to have strong muscles. When you do “Kegel exercises, it basically is a great work out for just those muscles. Unfortunately, it can be difficult for to identify the correct muscles to exercise.

General Guidelines

1) do not continually stop voiding by tightening the pelvic floor
muscles. This may eventually cause voiding problems.

2) try to keep your abdominal, thigh, and buttock (bum) muscles
relaxed while doing the exercises. If these muscles tense up, the
exercises end up being done incorrectly.

3) to help keep these auxiliary muscles of the pelvis (abdominal,
thigh, and buttock muscles) relaxed, breath normally while
doing the exercises. In particular, the patient should breathe out
as the muscles are contracted.

4) do not overdo the exercises in the mistaken belief this will
improve the problem faster. It may have the opposite effect due
to muscle fatigue.

5) last but not least, try not get discouraged. It may take some time (3 plus weeks) to notice changes but in the end, if the exercises work, it’s much better than having to come see a Doctor like me ☺

Regards,

Dr. Himel

photo credit: http://www.apta.org/AM/Images/APTAIMAGES/ContentImages/ptandbody/incontinence/kegels.gif

Bladder Control Problems - Embarrassment & Getting Back To The Business Of Your Life

The first patient I saw when I returned to practice was a sixty-three year old woman with urgency incontinence (the clinical way to say bladder control problems!). Before I had a chance to introduce myself she said “I’m here against my will. My daughter insisted that I come and see you, so here I am. I have already seen a doctor who made a diagnosis and gave me treatment. It didn’t work and I don’t think you can help me either.” I convinced her that since she was already here we could at least talk.

My new patient (to protect her identity let's call her 'Sue') babysat her school aged granddaughter 5 days a week. Approximately three months previously 'Sue'’s granddaughter went home and asked her mother why granny smells so bad.

After a complete history and physical examination and a review of her laboratory results and ultrasound reports, I agreed with the diagnosis which 'Sue' had been given by her previous doctor. While I didn't disagree with the course she had been given thus far, it wasn't working and we needed a different approach.

There are a number of medications available for this problem which fall in the general classification of “antimuscarinics.” Though these drugs are in the same class, they are physically slightly different from each other. Finding the right one for 'Sue' was the challenge.

After receiving treatment 'Sue' returned to my office two weeks later. I asked her how she was. She burst into tears. She was completely cured and from the time she started the new medication she had not had a single episode of incontinence. This wasn't just about a cure - it was about her getting over her embarrassment with her grandchild and getting back to the business of living her life.

My goal in this medical practice is to have this type of successful outcome to treatment as this woman. While it may not always work out that way, when it does, it has a profoundly amazing affect.

Regards,

Dr. Himel