URINARY INCONTINENCE

Urology Specialists of Ohio

Thank you for choosing the Urology Specialists of Ohio. Your care and well-being are our primary concerns, and we want your stay
to be as comfortable as possible. Please call us if you have any questions at (937) 342-9260

URINARY INCONTINENCE

What happens under normal conditions?

The bladder job is to store urine. When everything is working correctly, first the brain tells the bladder it is time to release urine then the urethral sphincter (circular muscle) relaxes and lastly the bladder muscle contracts. Incontinence occurs if closure of the sphincter is inadequate (stress incontinence) or the bladder muscle is overactive and contracts involuntarily (urge incontinence).

What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine and is not necessarily a part of aging. It is a common condition experienced by men and women of all ages.

What are the different types of urinary incontinence?

Stress Urinary Incontinence: Stress incontinence is typically associated with physical activity like coughing, laughing, sneezing, lifting, straining, getting out of a chair or bending over. Damage to the pelvic floor from child birth can lead to stress incontinence. This is also the most common type of incontinence in men that have had prostate surgery.

Urge Urinary Incontinence: Patients typically state “I can’t make it to the restroom in time”. This urge to urinate is caused by an overactive bladder. At times the patient may leak without warning, these patients typically wear depends or restrict liquids prior to an outing.

Mixed Urinary Incontinence: Mixed incontinence is a combination of urge and stress incontinence.

Overflow Urinary Incontinence: Overflow occurs when the bladder never completely empties, which causes urine to leak.

Non-Surgical Management Options

Some of the causes of incontinence are temporary and easily reversible. Reversible causes include urinary tract infection, vaginal infection or irritation, medication, constipation and restricted mobility. However, in some cases, further medical intervention is necessary. Minimally invasive treatment options are those treatments that do not involve surgery and should be the first line of treatment for patients. However, they may also be used in conjunction with surgical therapy.

Fluid Management: This option consists of instructing a patient to increase or reduce their fluid intake. Incontinent patients may need to reduce the amount of caffeine or other dietary irritants (such as acidic fruit juices, colas, coffee and tea), while at the same time increase water intake to produce an adequate amount of non-irritating, non-concentrated urine. A recommended water intake is six to eight glasses per day.

Kegal Exercises: Kegal exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. You can do Kegal exercises discreetly anytime or any place.

Pelvic Floor Exercises: This conservative, non-surgical therapy is used to treat incontinence, urgency, pelvic pain, or to re-educate the pelvic floor muscle to restore and maintain bladder health. The procedure tech will educate, evaluate, and instruct you on proper isolation and exercise of your pelvic floor muscles. Using biofeedback technology, a computer recorder monitors the strength of your pelvic muscles and your progress throughout the therapy. The computerized technology allows you to immediately see the results as you contract and relax the correct group of muscles according to a preset pattern of exercises. Think of this as your personal trainer while you “do a circuit” of exercises just as they do for muscles in the fitness centers. You will learn skills that will enable you to continue maintaining pelvic floor health throughout your life.

Electrical Stimulation during Biofeedback Therapy: Your physician may decide that your pelvic floor muscles could benefit from an extra boost of exercise which can be provided by directly stimulating these muscles. A very mild electrical stimulation causes the muscle to contract without your direct effort. Many people also report this offers a sensation that guides them in identifying the correct muscles to contract. The stimulation often is described as a tingling sensation – this is not painful- and is always adjusted to your specific comfort.

Pelvic Relaxation Therapy: The pelvic floor is a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum. Contracting and relaxing these muscles helps to control bowel and bladder functions. These muscles must relax to allow for urination and bowel movements. A computer monitors the strength of your pelvic muscles and your progress throughout the therapy. The computerized technology allows you to immediately see the results as you contract and relax the correct group of muscles according to a preset pattern of exercises. These visual and audio “clues” allow you to learn to contract and, even more importantly, to relax the pelvic floor muscles.

PTNS (percutaneous tibial nerve stimulation): Is a minimally invasive way to improve urge incontinence in men and women. A device is attached to a needle which is temporarily placed near the ankle. The device delivers mild electrical impulses which travel up the nerves in the leg to the nerves that control the bladder. Many patients see a reduction in the frequency and urgency of their bathroom visits and in the number of accidents they have.

Medication Treatments: Anticholinergics allow for relaxation of the bladder smooth muscle. These drug works well to treat urge incontinence but has side effects including dry mouth, confusion, constipation, blurred vision and an inability to urinate.

Surgical Management Options

Surgical options are only considered after a full evaluation. Typically non-invasive techniques will be tried prior to proceeding to surgical options. The physician will need to identify the type of incontinent because the surgical options are designed to work specifically for each type of incontinence.

Urethral sling surgeries: This surgery technique is used to treat stress urinary incontinence involves placing a sling around the urethra to lift it back into a normal position. The sling is attached to the abdominal wall.

The sling material may be muscle, ligament, or tendon tissue taken from the woman or from an animal, such as a pig. It may also be composed of synthetic material such as plastic that is compatible with body tissues or of absorbable polymer that eventually disintegrates.

Interstim: Interstim therapy is a neuromodulation therapy that targets the communication problem between the brain and the nerves that control the bladder. It is used to tread urge incontinence. The patient will go through a trial assessment where a temporary device is attached in an in-office procedure. Based on the outcome of the trial assessment the patient and physician may decided to proceed to a full implant, which is done under anesthesia at the hospital.

Inner Pages Welcome for Urology Specialists of Ohio Springfield Ohio

Thank you for choosing our group of doctors and staff for your Urology needs. In order for us to better serve you, below is a checklist of things to know and bring to your first appointment. If you do not have the paperwork filled out prior to your appointment, please arrive 15 minutes early to complete in the office. If you do not have the paperwork filled out prior to your appointment time then your appointment will be rescheduled to another date.

Urology Specialists of Ohio has been a committed part of the Springfield community for more that 10 years, and now serves Springfield, Beavercreek, London, Xenia, and Urbana striving to improve the medical community, with excellence in all areas of urology.

Our goals are to provide state of the art medical treatment for patients with genitourinary problems. We provide this in the most compassionate and cost effective way possible. We take pride in providing excellent care with attention to detail and respect in a friendly atmosphere.

Urology Specialists of Ohio would like to welcome you to the “Bladder Health” treatment plan. We understand this process can become very frustrating because it takes multiple steps. This is a layout of the plan the provider will likely follow. It has taken our body a long time to develop bladder issues therefore it will take us a little time to get to find the RIGHT SOLUTION FOR YOU! Please understand that each patient is different and the plan may vary slightly depending on each patient’s circumstances. If you have any questions during this process please contact our office. Our staff has been trained on every step and will be able to help answer questions.

1^st VISIT- OAB Consultation

A detailed history will be taken on this visit.
Bladder questionnaires will need to be filled out.
Review of medications that you have tried, typically your PCP has already given you one or more medications.
Behavior Management will be explained, here are a few examples.
- Do not drink after 7pm
- Be aware of fluids that irritate the bladder. (You will find a list in your packet).
- Kegel exercise.
Pelvic Floor Therapy or Biofeedback Therapy will be explained.
- This is a therapy that helps rehab the pelvic muscles. You will find a brochure in your packet.
- This therapy is required to be done 4 times. Please note that you may not notice a difference on the first couple sessions. Stick with it! You may be surprised at how much it helps rehabilitate your pelvic muscles.
Medication Management
- You may be asked to try another medication. Most insurance require the patient to try at least two medications prior to trying more advance techniques.
- Understand that we like you to report any side effects or problems with the medication as soon as you notice. Call the office and we will document this in your medical record.
Voiding Diary
- You may be asked to fill out a voiding diary. This may seem difficult or silly but it does tell us very useful information.
  - Keep the diary with you at all times. It is important to document EVERY urinary episode.
  - We need 3 days! We may not be able to proceed to the next step without 3 days of a “TRUE” voiding diary.
  - Do the diary about 3-4 days prior to the next visit. This give the physician the most current information.

#2. Visit- Pelvic Floor Therapy

You will not see the physician on this visit. Your time will be spent with the procedure tech.
This visit will take about 45 mins.

#3. Visit- Pelvic Floor Therapy

Again you will not see the physician on this visit. Your time will be spent with the procedure tech.
This visit will take about 30 mins.

#4. Visit- Pelvic Floor Therapy

Again you will not see the physician on this visit. Your time will be spent with the procedure tech.
This visit will take about 30 mins.

#5. Visit- Pelvic Floor Therapy

Again you will not see the physician on this visit. Your time will be spent with the procedure tech.
This visit will take about 30 mins.

#6. Office Visit- Review Medication, Behavior Modification, and Pelvic Floor Therapy

You will see the physician on this visit.
He will want to review the voiding diary that you have completed.
He will also discuss in detail how you did on the medication.
Please be prepared to discuss what behavior modifications you tried and how they worked.
The outcome of the pelvic floor therapy will be discussed.
After reviewing all these items he will decide if an Urodynamics test is required.
- Urodynamics tells us “what” is causing the problem. It will also help determine what the next step in your bladder treatment plan.
- Most insurances require an urodynamics test prior to proceeding to the next step.
- You have a brochure in your package to explain how urodynamic testing is done.
He will also decide if a Cystoscope is required.
- This is a procedure the physician does in the office to look inside the bladder.
- He will insert a small camera into the bladder which will allow him to visually look to see what maybe causing the bladder symptoms.
Visit 7 and 8 can be interchanged. It really doesn’t matter which one your do first.

#7. Visit- Urodynamics

You will not see the physician on this visit. Your time will be spent with the procedure tech.
This visit will take about 45 mins.
We would like you to arrive with the “urge” to use the bathroom. Do not drink extra water but do refrain from using the bathroom for a couple hours prior to the test.
You have a brochure that explains exactly how the test is done in your packet. If you have any further questions please call the office. This is an important part of the process and we wouldn’t want you to not do the test because of unanswered questions.

#8. Visit- Cystoscope

You will see the physician this visit, but you will be brought back by the procedure tech. She will prepare you for the procedure. She will also be in the room assisting the physician with the procedure.
The procedure takes about 10 mins but be prepared to be in the office for about 30 mins.
You may be given an antibiotic to take after the procedure. This is just to insure, no infection occurs.

#9. Visit- Determine Final Therapy

You will see the physician on this visit.
The physician will review everything and determine what procedure will best help with your bladder diagnosis.
There are many different types of procedures that maybe suggested from surgery to different procedure done in the office. Because each patient’s body/ bladder is different we cannot pre-determine which one may help you best without going through the WHOLE process.
- Surgical candidates will have the exact surgery explained to them at this visit.
  - Review Robotic Sacrocopolexy brochure that is in packet.
- Botox candidates will have the procedure scheduled at this visit.
  - Botox is done in the office.
  - Needs to be repeated every 6 months.
  - Please review brochure that has been placed in your packet.
- InterStim candidates will have the procedure scheduled at this visit.
  - InterStim is a test we do in the office to determine if the nerves can be fixed.
  - If the in-office test works then the device will be placed in the hospital.
  - Please review brochure that has been placed in your packet.
- PTNS (URGENT PC) candidates will have the procedure scheduled at this visit.
  - PTNS is a procedure that helps the nerves.
  - It is done in the office.
  - This procedure is done once a week for 6 weeks.
  - Please review brochure that has been placed in your packet.