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Incontinence Issues

Brian Christine, MD, is in practice at Urology Centers of Alabama in Birmingham, Alabama, and is board certified and a member of the American Urologic Association, the Society of Prosthetic Urologists and the Sexual Medicine Society of North America.
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Q:

I am incontinent and have been for years. Recently I took a trip and tried to get by without the diapers. I ended up in the hospital with a severe urinary tract infection. Could the fact that I tried to go without the diapers caused the infection? 


David
A:

David, first off, I am sorry that you have been suffering with urinary incontinence. If you have not done so, I would suggest that you be evaluated by a urologist since we have very, very good treatments available for incontinence. It is a very rare patient we cannot help. Second, I doubt that the urinary tract infection was caused by not wearing diapers for a few days. I do not think simply foregoing the protective garment was associated at all with the infection. The fact that you had a severe urinary infection is another reason you should be evaluated by a urologist. I hope this is helpful. Again, don't suffer needlessly with urinary incontinence; a urologist can probably help.
 

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Q:

How long is a proper length of time to leave a catheter in a person? My mom has a broken hip, but refused to have an operation, so she's been laid up for 2 months in bed now. I do not want her to lay in her urine all night long every night, but I can not get up every night to change her diaper either because I have a business that require my attention 12 hours a day, 7 days a week. So if I put a catheter in her, how often do I need to change it? 


Sumei from AZ
A:

We like to change a catheter about every four weeks. For the patient who is requiring long term catheterization, studies have shown that changing the catheter every 4-6 weeks is ideal. Changing the catheter in your mother should be a pretty easy process, and I suspect that you could even have a home health care nurse come to do that for you. That would save you having to take your Mom to the doctor’s office. In any event, I would recommend you get that catheter changed every month. I hope this helps. 

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Q:

My mother in law is 82 years and has Alzheimer's. She is continually wearing diapers and her caregivers toilet her during the day, every 3-4 hours and she is showered daily. She has UTIs every 2-3 months and although there is no change in her functioning, no fever, she has hematuria, sometime with clots. We are asking her caregivers to clean her well, they use unscented baby wipes, give her lots of fluids and she has 2-3 8 oz glasses of cranberry juice daily. Is there any other preventative measure we can try? Thank you for any advice. 


Susie
A:

Addressing the urologic needs of the elderly can be very challenging. Your grandmother seems to have incontinence, and it would be helpful to be sure she is adequately emptying her bladder. If she is not emptying her bladder the urine that does not empty could potentially set her up for recurrent urinary tract infections. If she is emptying her bladder normally (a urologist can check this easily in their office), she may well benefit from a daily, low dose prophylactic antibiotic. Recurrent infections often times can be prevented by taking a daily antibiotic tablet. This would likely be continued for the foreseeable future. I hope this is helpful.  

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Q:

My Mom’s doctor said that they do not generally treat bladder infections in the elderly unless they are running a fever or acting strangely. He said that if you tested all the patients in nursing homes at least 50% would show positive for bacteria in the urine. This to me sounds like patient neglect. Is this a common theory? I would not want to wait until a fever shows up and discover a kidney infection. 


LM from MA
A:

Thank you for the question. It is true that we often times do not treat asymptomatic bacteria in the urine of elderly patients. Asymptomatic urinary tract infections are not uncommon in elderly men and women (especially women). If the patient has no complaints of a urinary tract infection (discomfort with voiding, blood in the urine, increased frequency of urination or fever) it is reasonable to not prescribe antibiotics. The logic is that if a person has some bacteria in the urine, but not real complaints, giving antibiotics may merely allow more vigorous and more resistant bacteria to grow in the urine causing a much greater problem for the patient. So, not treating an asymptomatic growth of bacteria in an elderly patient's urine is really not patient neglect at all. 

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Q:

I am a caregiver to my mom who is 72 years old. She recently started to have bladder problems and now is using pads, but she says that they are uncomfortable to wear at night. She was given medication for her bladder problem, but it is not working. She is totally embarrassed about her situation. She has been taking thyroid medication for years, but recently started having side effects from it. I’ve heard from some other people that they are having to urinate a lot on the thyroid med that she is taking. Could you please help me?  


Helena from NM
A:

Regarding your 72 year old mother who has bladder problems, I first want you to know that as we get older urinary issues and urinary incontinence are not tremendously unusual. In our question you said that your mother has been given medication for her “bladder problem,” but the medication is not working. Though I don’t know for sure, I presume that her bladder problem is urinary incontinence, and I expect that it is likely incontinence that occurs with an urge to urinate. Symptoms of an “overactive bladder” can include urinary incontinence. This is usually best treated with medication. However, there are other bladder conditions that can cause urinary leakage. A urinary tract infection can cause leakage of urine. An infection would best be treated with antibiotics. Also, there is a condition called “stress incontinence” where urinary leakage occurs with a stress to the bladder. The kind of stress that I am referring to is not emotional stress, but rather is pressure that gets exerted onto the bladder when a patient coughs, laughs, sneezes or tries to do more vigorous activities. Knowing exactly what your mother’s specific complaints are would be required before a particular plan of treatment could be initiated. I think the first step would be to have your mother evaluated by a urologist. If you have already done that, then she would need to return to see the urologist if her symptoms have not improved and if she is having continued difficulties. I hope that this answer has been helpful to you. I am glad that your mother has a daughter like you to help care for her. 

 

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Q: I have a 32 year old son who was born with spina bifida. He has a neurogenic bladder. It was made larger when he was about 10 years old. [Doctors] do not feel that his bladder is large enough for the man he has become. He has leakage every time he strains and has always had to wear some kind of protection like disposable briefs. Do you feel like there might be some type of surgery for him to have a more normal lifestyle? He is really a great person who has had a lot of hardships in life. Thank you for your time.
Janet from TN
A:

Q: Janet, you indicated that your son has spina bifida and had a bladder augmentation when he was about 10 years old. The bladder augmentation is designed to increase the capacity of the bladder, and that is a fairly standard procedure to do for a child who has spina bifida. Unfortunately, he has urinary incontinence, and I know that is very distressing for him. There may well be a procedure that could be done to treat his urinary incontinence, and I think that probably there is a treatment that would be available for him. However, to truly evaluate him, he would need to be seen and certain bladder testing procedures would need to be done. None of these things are painful or uncomfortable, but they would give us a much clearer picture as to the issues associated with his urinary incontinence. It is rare that we can’t help a patient who has incontinence.

I would encourage you and your son to find a urologist who has a true interest in treating male incontinence and who has been well trained in the techniques and devices used to treat incontinence. Not every urologist has extensive experience with anti-incontinence procedures and devices. In fact, most do not. I hope this has been helpful. Please do not hesitate to contact me if I can be of any further assistance to you or to your son. Good luck! Please know that in all likelihood, there IS something that can be done to help your son.
 

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Q: After a stroke of 5 years my husband has been unale to hold his urine for any great length. He has taken medicines for this and now he is on cardura 4 mg. He has had the urodynamic studies and they determined he cannot empty his bladder completely. Is there anything else that can be done, as all the meds he has taken seem to work against his dilantin that he has to take for seizures. Do you recommend that he continue this or just stop all meds for incontinemce? Is there any danger if he stops the medication, and just wears the diapers?
Bobbi from NC
A:

Let me try to answer the question that you posed about urinary incontinence. Let me first say that I am sorry that your husband has to deal with the affects of having had a stroke and having to deal with urinary incontinence.

Urinary incontinence is a significant problem; the quality of life issues associated with incontinence are tremendous. You indicated in your e-mail that your husband has had urodynamic studies and the studies have determined that he cannot empty his bladder completely. It would be important to try to figure out why he can't empty his bladder. If he can't empty his bladder because the bladder muscle does not function properly that is one issue; however, if he can't empty his bladder because of an enlarged prostate then that would require a completely different treatment approach. Oftentimes, this can only be determined by actually performing a cystoscopy in the office. A cystoscopy is actually looking inside the urethra and bladder with a flexible telescope. You also indicated in your e-mail that he is on Cardura and that is a medication that we typically use for men with an enlarged prostate.

Therefore, I think that complete evaluation for your husband would involve cystoscopy and a physical examination in the office. I am always hesitant to have patients simply "stop their medication" without knowing more specifics about their situation. I would encourage you and your husband to make sure that you consult his urologist as to what he or she thinks should be done next. I am certainly happy to help as much as I can from my standpoint.

I hope that this has been helpful to you.

Brian Christine

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Q: Do bedwetting training devices work for adults/seniors who take care of themselves and have urinary incontinence?
Suzanne from CA
A:

In my experience, the bedwetting alarms have primarily been used in the pediatric population. Most of these patients sleep too soundly and therefore do not perceive the urge to void and they wet on themselves before they can get to the bathroom. Most of these younger patients are in the process of going through potty training and the maturation of the nervous system is not complete yet and the bedwetting alarms seem to just help these patients learn to control their urine over a period of time. In the adult population, these patients have already learned potty training but now due to Alzheimer’s, strokes, decreased mentation, the micturition reflex has been affected or they don’t ambulate very well and they can’t get to the bathroom fast enough because of a physical problem. I have never used the bedwetting alarms in this population and personally I doubt if they are going to be worth the expense. If somebody has access to one of these devices, maybe one has been donated or has been used in the past and still works, there is nothing wrong with trying it. It is certainly not going to harm anything, but I just don’t think it is going to be successful in this elderly population.

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Q: My mother has tried all the medications available for incontinence and even InterStim to improve her frequency issues, but to no avail. Will she just have to live with this condition?
Alice from HI
A:

Unfortunately, it sounds like your mother has a very severe case of urinary frequency and urgency. The typical treatment is medications, and for the most severe cases we do occasionally use the InterStim sacral nerve stimulator. At this point it may well be that your mother will have to simply coexist with her symptoms. However, if her urologist has not performed Urodynamic studies, these would be indicated. Urodynamic studies are detailed testing of bladder function done in a urologist’s office. It would also be reasonable to have your mother undergo a cystoscopy, which is a telescopic examination of the inside of her bladder. The Urodynamic studies and the cystoscopy are not painful and they should be done if they have not yet been done. If these investigations reveal that your mother’s problem is simply just an overactive bladder, one other option available to her would be injections of Botox into her bladder muscle. This is done through the cystoscope and can be quite effective. Since most urologists do not do Botox injections, she may need to seek out an individual who routinely does these injections.

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Q: Will “light bladder leakage” in women get worse with time or can patients take steps to prevent that?
A:

Urinary incontinence in women is, unfortunately, not an infrequent occurrence. There are two types of urinary incontinence in women and these are referred to as “stress incontinence” and “urge incontinence.” Stress incontinence is that leakage of urine that occurs when a patient laughs, coughs, sneezes or does more vigorous physical activity. This stress incontinence is caused by a weakening of the supportive muscles of the pelvic floor; this leads to bladder movement with activity and a leakage of urine. Stress incontinence is most effectively treated with surgery. Women can also perform Kegel exercise to strengthen the pelvic floor muscles. Your urologist or gynecologist can explain to you how to perform Kegel exercises. The other kind of urinary incontinence, urgency incontinence, is that leakage of urine that occurs with a strong desire to void. Women will often say that they get the urge to urinate, but simply can’t make it to the bathroom in time and wet on themselves. This type of incontinence is most effectively treated with medication. There are a variety of medications on the market that can be beneficial for urgency incontinence. It is important for women to realize that their urinary incontinence can most often be effectively treated, and we encourage them to speak to their urologists or gynecologists about this problem.

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Q: Does incontinence following cancer treatment go away by itself or will it be permanent?
A:

Radical prostatectomy remains an important treatment option for organ-confined prostate cancer. Unfortunately, a small percentage of patients who had their prostate removed will have persistent urinary incontinence. Typically, within 6 to 12 months, a man who has had his prostate removed will gain back complete control of his urine; however, for that small percentage of men who do not, there are treatment options available. A device called an artificial urinary sphincter is a synthetic cuff that is placed around the patient’s urethra and can provide good control of the urinary stream. The artificial urinary sphincter is a tried and true product and has been around for 30 years. Patients with the most severe degree of post prostatectomy incontinence are candidates for the artificial sphincter. A more recent development to treat urinary incontinence following radical prostatectomy is the male sling. The sling is designed for men who has a mild to medium degree of leakage and is very, very effective. The most important point to remember is that urinary incontinence following radical prostatectomy will most often resolve itself. For those patients who have persistent incontinence there ARE very effective treatment options available! We certainly encourage those patients with urinary incontinence after radical prostatectomy to speak to the urologist about the problem, and also to find urologists who are well trained in the treatment of post prostatectomy incontinence.

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