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Urology (Expert Forum)
Re: incontinence
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Re: incontinence
by hfhs M.D.-AK, Jan 01, 1995 12:00AM
Posted By HFHS M.D.-AK on March 17, 1999 at 05:42:47:
In Reply to: incontinence posted by mary keenan on March 06, 1999 at 13:53:35:
I am a 38 year old female, and have had 1 miscarriage in Jan.99
Otherwise, no history of pregnancy. I started to do Kegal exercises and realized (before the m/c) that the urine leakage and nondescript left pelvic discomfort had decreased. I have the diagnosis of Piriformis syndrome from a old car accident. The Kegal exercises ( which helped initially ) seems to be hard to perform.They are not painful, just hard to do. Any suggestions?
Dear Mary,
It sounds like you have stress incontinence. You should see a urologist for a full history and physical before any recommendations are made. Im not sure what you mean by the Piriformis syndrome, but I do know where that muscle is in relation to the bladder.
It is true that child bearing can have an effect on stress urinary incontinence which is what you probably have However, the stress urinary incontinence is usually a consequence of multiple deliveries which you really didnt have. Stress urinary incontinence is divided into three categories (primarily divided by the fluoroscopic or radiologic evaluation). The definition of stress urinary incontinence(SUI) denotes involuntary loss of urine when the total intravesical pressure exceeds the maximum urethral pressure in the absence of bladder activity(contraction). To determine which type of incontinence you have, you would first need a complete urodynamic work-up before a floroscopic exam is done. First this will confirm that your incontinence is stress incontinence and second, this will tell us the pressure at which you begin to leak. Again with florourodynamics, Type 1, is incontinence without primary sphincter incompetence and on fluorourodynamics(FUDS) a bladder above the pubic symphasis. Type two SUI is a competent sphincter with a bladder below the pubic symphasis on FUDS. Type three SUI what you probably have is an incompetent urinary sphincter(weak muscle). On the pressure portion of your study, this would mean that your bladder would leaked at a pressure below 90 cmH2O.(some Urologists use a threshold of 100 cmH2O.)
In regards to the Kegal exercises, it sound like these exercises initially helped you remain continent however, dont seem to be keeping you dry. Kegal exercises are good to a certain extent, but need to be maintained or the effect is lost. You state that they are hard to do, I dont know if your pelvic floor muscles are getting weaker or you just are having difficulty isolating the appropriate muscles. If you see a Urologist, he or she can not only direct your work-up, but also treat you if something is found. Anyways, at least the urologist can explain to you what your problem is, and then you can decide if you want it fixed.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Incontinence
In Reply to: incontinence posted by mary keenan on March 06, 1999 at 13:53:35:
I am a 38 year old female, and have had 1 miscarriage in Jan.99
Otherwise, no history of pregnancy. I started to do Kegal exercises and realized (before the m/c) that the urine leakage and nondescript left pelvic discomfort had decreased. I have the diagnosis of Piriformis syndrome from a old car accident. The Kegal exercises ( which helped initially ) seems to be hard to perform.They are not painful, just hard to do. Any suggestions?
Dear Mary,
It sounds like you have stress incontinence. You should see a urologist for a full history and physical before any recommendations are made. Im not sure what you mean by the Piriformis syndrome, but I do know where that muscle is in relation to the bladder.
It is true that child bearing can have an effect on stress urinary incontinence which is what you probably have However, the stress urinary incontinence is usually a consequence of multiple deliveries which you really didnt have. Stress urinary incontinence is divided into three categories (primarily divided by the fluoroscopic or radiologic evaluation). The definition of stress urinary incontinence(SUI) denotes involuntary loss of urine when the total intravesical pressure exceeds the maximum urethral pressure in the absence of bladder activity(contraction). To determine which type of incontinence you have, you would first need a complete urodynamic work-up before a floroscopic exam is done. First this will confirm that your incontinence is stress incontinence and second, this will tell us the pressure at which you begin to leak. Again with florourodynamics, Type 1, is incontinence without primary sphincter incompetence and on fluorourodynamics(FUDS) a bladder above the pubic symphasis. Type two SUI is a competent sphincter with a bladder below the pubic symphasis on FUDS. Type three SUI what you probably have is an incompetent urinary sphincter(weak muscle). On the pressure portion of your study, this would mean that your bladder would leaked at a pressure below 90 cmH2O.(some Urologists use a threshold of 100 cmH2O.)
In regards to the Kegal exercises, it sound like these exercises initially helped you remain continent however, dont seem to be keeping you dry. Kegal exercises are good to a certain extent, but need to be maintained or the effect is lost. You state that they are hard to do, I dont know if your pelvic floor muscles are getting weaker or you just are having difficulty isolating the appropriate muscles. If you see a Urologist, he or she can not only direct your work-up, but also treat you if something is found. Anyways, at least the urologist can explain to you what your problem is, and then you can decide if you want it fixed.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Incontinence
