BACKGROUND: Urinary incontinence occurs when a person is unable to control their bladder and so they also have difficulty controlling urination. Some individuals with incontinence “leak” when they sneeze or cough while other people wet themselves on a regular basis because the urge to urinate comes on so strongly and quickly they can’t make it to the bathroom. Incontinence is a common problem which can be caused by a multitude of things including underlying medical conditions or physical problems. (Source: www.mayoclinic.com)
TYPES: Urinary incontinence can be categorized into a few different groups. Some types of incontinence are:
- Stress Incontinence – Stress incontinence refers to when the bladder releases a little urine when pressure, such as from a sneeze, is put on the bladder. This is often the result of an event that weakens the muscles in the bladder such as giving birth.
- Urge Incontinence – This is when the urge to urinate comes on very suddenly followed by involuntary urination. People with urge incontinence may also feel the need to urinate more often than normal.
- Overflow Incontinence – This type of incontinence is when a person is leaking small amounts of urine throughout the day. Because the bladder cannot empty completely, the remaining urine dribbles out constantly. (Source: www.mayoclinic.com)
RISKS: Certain factors can make a person more likely to experience urinary incontinence. One risk factor is sex because women have a higher risk of stress incontinence because the go through events such as pregnancy, birth, and menopause which can all cause loss of bladder control. Being overweight can also put extra pressure on the bladder and raise the risk of incontinence. More seriously, certain conditions are associated with incontinence including overactive bladder, kidney disease, or even diabetes. In addition to being embarrassing, urinary incontinence can also lead to repeated urinary tract infections and skin problems like rashes or sores. (Source: www.mayoclinic.com)
NEW TECHNOLOGY: InterStim is a device used to control urinary incontinence in people who do not have a urinary blockage and have not been able to treat their incontinence with other methods. The device is placed in the upper buttock region during a surgical procedure and it uses electrical pulses to help the communication between the sacral nerves and the brain, which are involved in bladder control. There are currently over 100,000 individuals with device and InterStim is removable if the person no longer wishes to have the device. (Source: www.medtronic.com)
John C. Pope IV, MD, Professor of Urologic Surgery and Pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, discusses a new device helping children overcome urinary incontinence.
Let’s talk about urinary incontinence in kids. When you think about it you might think of an older population, but it’s a problem that happens in children as well; correct?
Dr. Pope: Correct.
How big of a problem is it?
Dr. Pope: It is one of the most common problems that we see in children. Urinary incontinence affects a large portion of the pediatric population, primarily from about the age of potty training until seven, eight, nine years old. It is typically more common in girls than boys but it does affect both genders.
We’re not talking bed wetting at night; we’re talking day time?
Dr. Pope: Correct. Bedwetting or night time wetting is a totally different problem that is considered normal even in children up to teenage years. This is a daytime problem; we should see continence during the day in most children after the age of two and a half to three.
So if it doesn’t go away, what’s the next step? What kinds of therapies are out there and is it medicinal or is it therapeutic?
Dr. Pope: The initial treatment is what we call conservative management, or behavioral management. One of the most common problems these kids have is they hold their urine for long periods of time and they don’t ever want to go to the bathroom; they’re busy playing, watching TV, and being outside. For whatever reason, they’re distracted and they don’t want to stop what they are doing and go to the bathroom so they just hold it indefinitely. One of the solutions that we have initially is to put them on what’s called a timed voiding schedule where we have them go to the bathroom to urinate every hour and a half to two hours to make sure that they get themselves on a good schedule. A couple of other things that we try initially are to make sure they’re not constipated. Constipation is one of the most common causes of urinary tract problems in these children. There are a lot of things in the diet that can also cause bladder irritation and bladder over-activity that would lead to incontinence.
If you try all these methods and they don’t work, what options are left for parents and kids?
Dr. Pope: If those options don’t work the next step would be to try some medications to relax the bladder. This is really a problem of bladder over-activity. So if behavioral modification, dietary modification don’t solve the problem, then we’re really looking at trying a medication to try and relax the bladder and slow the bladder down so that it’s not causing incontinence problems
Have you had cases where neither of those options worked?
Dr. Pope: Probably ninety percent of the cases are solved by one of those two methods, either behavioral or medication. We have about ten percent of these children that we consider intractable or refactory to our standard treatment methods, and then those are the children that usually require more diagnostic testing and potential treatment.
Have they been effective? The alternative treatments for the ten percent that behavioral or medicinal didn’t work on? Before this what was available?
Dr. Pope: Well before this there wasn’t a whole lot available. We tried what’s called biofeedback where we have a computer device, a gaming device, that we can connect to the various nerves and muscles that work the bladder and the sphincter so that they can then interact with this computer game and try to learn how to better empty or control their bladder. If that doesn’t work then there really weren’t any other options; we didn’t really have anything else to offer them.