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Urinary incontinence is the involuntary loss of urine severe enough to have adverse social or hygienic consequences.

More than 10 million women suffer from chronic urinary incontinence in the U.S. alone. One in four women ages 30-59 has experienced an episode of urinary incontinence. This high incidence among women can often be traced to the trauma of pregnancy and childbirth, which weakens the nerves and muscles of the pelvic floor.

The embarrassment of incontinence leads many to avoid social contacts, leading to isolation and an increase in suffering. Still, more than half of those who suffer with bladder problems will not seek medical help, even though research has shown that more than 7 out of 10 patients can experience improvement, if not total continence restoration, with behavioral treatment.

With this success rate there is no reason to avoid seeking treatment. Contact a
Liberty® Support Specialist today for additional information you can use to discuss your condition with your doctor.

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The urinary system consists of the kidneys, ureters, bladder, urethra, and the pelvic floor muscles.

The
kidneys function as a filter to remove waste products from the blood stream. These waste products (urine) are moved through the ureters for storage in the bladder. The bladder is composed of smooth muscles that relax during bladder filling. The relaxed muscles help the bladder expand like a balloon to accommodate the storage of urine. Urination begins when these muscles contract forcing the urine out of the bladder. The urethra, which extends from the base of the bladder, is a hollow muscular tube that allows emptying of the bladder. At the connection of the urethra to the bladder is a group of circular muscles called sphincters, which act as a valve that controls the flow of urine. This urethral sphincter contracts (the valve is closed) during bladder filling and storage, and relaxes (the valve is opened) during emptying.

The brain and spinal cord regulate this complex system, and a malfunction in any part of this system can lead to incontinence.

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Stress Incontinence
Stress Incontinence is a bladder storage defect. The bladder is unable to store urine until voluntary urination occurs. This is either due to pelvic support problems, such as weak surrounding muscle, a urethral sphincter defect, or both. The pelvic muscles that ordinarily force the urethra closed do not squeeze as tightly as they should. Urine is lost when the patient laughs, coughs, sneezes, or performs any physical activity that increases the abdominal pressure to a level which overcomes the bladder's retention capability. Stress Incontinence is the most common form of urinary incontinence, accounting for approximately 40% of all cases. It is most common among women under 60. Treatments for Stress Incontinence focus on toning pelvic neuromuscular tissue.

Urge Incontinence
Urge Incontinence, or Detrusor Instability, is a bladder filling defect. Involuntary muscle contractions cause a loss of urine. A common symptom is a strong and frequent desire to urinate. Normally, bladder muscles allow slow filling by expanding. As the bladder fills, nerves are stimulated to send messages to the brain.

For those with urge incontinence, the bladder may inappropriately contract at any time during filling. This occurs when the nerve and muscle systems from the bladder to the brain are damaged or malfunctioning. Patients may describe a sudden urge to urinate and an involuntary loss of urine associated with touching or hearing running water, touching their doorknob when entering their home, drinking a small amount of liquid, or during sleep. Urge Incontinence accounts for about 30% of all cases and is more common among older adults. Treatments for Urge Incontinence work on calming the involuntary bladder muscle contractions and retraining the bladder function.

Mixed Incontinence
Mixed Incontinence is a combination of stress and urge incontinence and accounts for about 30% of all cases. Older women are most likely to experience this combination incontinence.

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The U.S. Department of Health and Human Services' Agency for Health Care Policy and Research has established clinically accepted standards for the diagnosis and treatment of urinary incontinence. These standards, developed by an expert panel of doctors, nurses and other health care specialists, recommend the least invasive treatments as the first choice for sufferers of incontinence.


Behavioral Therapies (least invasive)

 
Pelvic Muscle Exercises or Kegel Exercises can substantially improve, and even prevent, urinary incontinence. Properly performed Kegel exercises increase the strength of weakened pelvic floor muscles, reducing or stopping involuntary leaks associated with Stress Incontinence, and improving control over the urgency brought on by involuntary bladder contractions associated with Urge Incontinence.

 
Pelvic Floor Stimulation (PFS) uses a special electrical signal, or waveform, that automates Kegel exercises. One electrical waveform exercises and strengthens the muscles of the pelvic floor to treat Stress Incontinence. A different electrical signal is used to treat Urge Incontinence. This signal works to calm involuntary bladder muscle contractions. Mixed Incontinence is treated by alternating the two electrical signals in a special treatment schedule. Pelvic Floor Stimulation has clear advantages over Kegel exercises because it always exercises the correct muscles, permits treatment of patients without enough muscle strength to correctly perform the exercises, and does not require active concentration on what can be a very demanding exercise schedule. Clinical research studies report greater than 70% "significant improvement" rates for Stress, Urge and Mixed Incontinence using PFS.

 
Biofeedback is a monitoring tool to measure pelvic muscle activity, which helps increase patient awareness and control of pelvic muscle contractions when performing Kegel exercises. A clinician may also use biofeedback to measure the success of PFS therapy.

 
Vaginal Weight Training is a method for strengthening the pelvic muscles by holding a series of progressively heavier specially-shaped weights within the vagina when tightening the pelvic muscles. Vaginal weights are only used in the treatment of Stress Incontinence.

 
Bladder Training is a group of techniques that instruct an individual to resist the urge to urinate and gradually expand the time intervals between urination. These techniques are helpful in the treatment of Urge Incontinence.


Drug Therapies (more invasive, with possible side effects)

 
Oxybutynin and Tolterodine Tartrate relax the bladder muscles to help reduce the spasms associated with Urge Incontinence.

 
Estrogen, taken orally or vaginally, may be helpful in treating postmenopausal women. Estrogen may be effective only when used along with other treatments.


Surgical Therapies (most invasive)

 
Sling Procedures are surgical procedures that use natural tissue or artificial material to create a sling that supports the bladder. The ends of the sling are attached to the pubic bone or attached to the abdomen above the pubic bone. Sling procedures can cure stress incontinence for 4 years in 80 percent of cases, but do often require repeat surgeries. These procedures have a moderate risk of infection.

 
Bulking Injections. A bulking agent like Collagen is injected into the tissue surrounding the bladder neck and urethra to add bulk and help close the bladder opening. Repeat injections are often necessary, since the body works to eliminate the Collagen. This technique is used to reduce Stress Incontinence.

 

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