Why Choose Cedars-Sinai Marina del Rey Hospital for Urinary Incontinence Treatment?
The highly skilled, well-trained urologists at Cedars-Sinai Marina del Rey Hospital evaluate patients with urinary incontinence and advise an individualized treatment plan. There are several conservative and surgical treatment approaches to treat urinary incontinence. The treatment that is thought to best suit the condition is chosen.
Urinary incontinence (UI) is the term used to explain the loss of bladder control. Patients with UI experience accidental leak of urine from their body. A man may feel a sudden, strong urge to urinate before leaking a substantial amount of urine (urgency incontinence). UI can sometimes be very debilitating. In some men, this condition can cause emotional distress as they try to avoid activities they enjoy such as exercises, which leads to inactivity and a higher chance of developing health problems such as obesity and diabetes.
The chances of urinary incontinence in men increase with age as men are likely to develop prostate gland problems with advancing age. Urinary incontinence is a problem that occurs in about 11-34% of elderly men, and around 2-11% of old men report that UI is a daily concern.
Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Urinary Incontinence
Surgery for the treatment of urgency urinary incontinence is considered as a last resort when all other conservative treatment methods have been ineffective. The surgical treatment includes the implantation of an artificial urinary sphincter (AUS) and a male sling under regional or general anesthesia.
- Artificial urinary sphincter (AUS): this device has three portions - a cuff that will fit around the urethra, a small balloon-shaped reservoir which is placed in the abdomen, and a pump that will be placed in the scrotum. This device is implanted in order to maintain the urethra closed until there is an urge to urinate. A liquid fills the cuff so that it fits tightly around the urethra and prevents the leakage of urine. When intending to urinate, the individual will squeeze the pump portion and deflate the cuff releasing the liquid to move up to the balloon reservoir. Then, the urine flows from the urethra. When the bladder empties, the cuff refills again to maintain tight closure of the urethral opening.
- Male sling: A sling procedure, which is also called urethral compression procedure, is performed in order to provide additional support to the urethra and control urination better. This surgical procedure involves the lifting as well as the compression of the urethra. An incision is made in the perineum (the area between the scrotum and the rectum), and then a mesh or a piece of tissue of human origin is used to compress the urethra towards the pubic bone. The tissue/mesh ends are attached to the pelvic bone.
Drugs and Other Treatment Needed for Urinary Incontinence
Bulking Agents »
Behavioral and Lifestyle Changes »
Electrical Nerve Stimulation »
Urinary incontinence in men is classified into the following types:
Urgency Incontinence »
Transient Incontinence »
Functional Incontinence »
Overflow Incontinence »
Stress Incontinence »
Symptoms of Urinary Incontinence
The symptoms of urinary incontinence may vary in their severity and can range from mild dribbling to involuntary, uncontrollable urination. The most common symptoms include:
- frequent urge to urinate
- not being able to control the urge to urinate even for a short time (until reaching a bathroom)
Diagnosis of Urinary Incontinence
The diagnosis of UI is made on the basis of a detailed medical history, physical examination, and certain diagnostic tests. During the physical examination, your doctor will check for signs suggestive of medical conditions that are associated with UI. Neurologic testing is done if necessary.
Digital Rectal Examination: this involves the use of a lubricated, gloved finger to check for masses or stool in the rectum and whether there is tenderness or enlargement of the prostate gland.
Diagnostic Tests: the following tests may be ordered to have a better understanding of the condition lying behind UI:
- Urinalysis: during this test, the patient collects the sample of urine in a container and a dipstick (chemically treated paper strip) is dipped into the urine sample. If there is a change in color, it indicates signs of urinary infection.
- Urine Culture: a part of the urine sample is kept in a special dish along with a media that promotes bacterial growth. There will be bacterial growth in 1-3 days if there is an urinary infection.
- Blood tests: these tests are done to check for kidney function problems and to assess the prostate-specific antigen (PSA) level (higher in prostate cancer).
- Urodynamic testing: this test assesses the ability of the bladder to hold urine and empty completely, and it includes the following:
- Uroflowmetry: this test measures the speed at which the bladder releases urine.
- Postvoid Residual Measurement: this test evaluates the quantity of urine that is remaining in the bladder even after urination. This suggests a blockage in the urinary tract.
Risk Factors for Urinary Incontinence
The risk factors that increase a man's chances of developing UI include:
- birth anomalies - developmental abnormalities in the urinary tract
- past history of prostate cancer radiation or surgical treatment of prostate cancer can cause UI
The most common risk factors of UI include surgery for prostate cancer (radical prostatectomy or for benign prostatic hyperplasia transurethral resection of the prostate) that often lead to intrinsic sphincter deficiency. Trauma to the neck of the bladder or prostate gland that may result from a pelvic fracture is a less common risk factor.
Other contributing factors of age-related UI include weakening of connective tissue, genitourinary atrophy, increased incidence of contributing medical conditions, and disability in mobility and cognitive functioning.
Apart from these, the factors that can increase the risk of developing UI include:
Causes of Urinary Incontinence
Urinary incontinence is a result of improper signaling from the brain to the bladder. The muscles of the bladder may either contract excessively or minimally due to the malfunctioning of the nerves that control the bladder muscles. The sphincters do not function well because of damage to the sphincter muscles or their nerves. Sometimes, UI may develop as a symptom of other conditions such as:
- Benign prostatic hyperplasia (BPH) — in patients with BPH, the enlarged prostate gland presses over and narrows down the urethra. The wall of the bladder becomes thick. Urinary retention occurs due to the weakened bladder that loses its ability to empty completely. The narrowing down of the urethra combined with incomplete emptying of the bladder may cause UI.
- Chronic cough: continuous coughing exerts pressure on the pelvic floor muscles and the bladder.
- Nervous system disorders: conditions that occur due to brain and spinal cord malfunctioning may be associated with uncontrollable urination
- Lack of physical exercise: reduced activity can lead to excessive body weight and muscle weakness.
- Being obese: excess weight exerts pressure on the bladder and decreases the capacity of the bladder to hold urine.
- Advancing age: as one grows older, the muscles of the bladder become weak and the bladder will lose its capacity to hold urine for a long time.
Alternative treatment for urinary incontinence includes the following:
Kegel Exercises: these exercises strengthen the pelvic floor muscles. The exercise involves holding the pelvic floor muscles tight for some time (about 10 counts) and then relaxing it for about 10 counts. This is to be done 20 times, twice a day.
Biofeedback: this helps exercise the right way as it involves the use of a specific machine that indicates which muscles you are exercising.
Relaxation techniques: these methods help you retain urine in your bladder for a longer time before urinating.
Bladder Retraining: this helps your body to get accustomed to regularly spaced bathroom trips.
Other alternative treatments such as acupuncture, hypnosis, Yoga, and herbal remedies may be useful. It is always necessary to inform your doctor about the herbs or supplements that you use.
Herbal remedies: a study has suggested the use of St. John’s Wort for the treatment of urinary incontinence.
Homeopathy: Generally, homeopaths advise the following remedies:
- Causticum: this is indicated in patients with stress incontinence.
- Pareira: this is indicated for urinary retention due to an enlarged prostate.
- Zincum: this is indicated in patients experiencing stress incontinence, urinary retention as a result of prostate problems.
Acupuncture: acupuncture may help strengthen the urinary system.
Here are some measures that could help prevent the development of UI:
- Quit smoking: avoiding smoking is essential to promote the health of your bladder. In fact, smoking increases the risk of developing stress urinary incontinence due to an increased likelihood of developing a cough. Smoking also increases the risk of bladder irritation and bladder cancer.
- Bladder training: involves maintaining a bladder diary and making a habit of using the restroom only at regularly spaced time intervals. This is called timed voiding and helps increase the time interval between your restroom trips.
- Pelvic floor muscle exercises: these exercises help strengthen the pelvic floor muscles that control the flow of urine. This allows holding back urine more effectively and preventing UI.
Are you suffering from problems with urination? For any questions, information or guidance related to urinary incontinence treatment, get in touch with our specialty-trained, skilled surgeons at Cedars-Sinai Marina del Rey Hospital.