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Bladder and Bowel Dysfunction

Forms of Urinary and Bowel Incontinence

OAB (Overactive Bladder)

OAB is a very common condition and becomes more common as one ages. As many as 33 million people suffer from OAB in the USA, probably more. Many people still don’t report this to their physician because they think it is a part of aging, or because they are embarrassed.

Symptoms

Urgency: The major symptom of OAB is a sudden, strong urge to urinate that you can’t ignore. This “gotta go” feeling makes you afraid you will leak urine if you don’t get to a bathroom within a few minutes.

Urinary incontinence: Sometimes people with OAB also have “urgency incontinence.” This means that urine leaks after you feel the sudden urge to go.

Urinary frequency: You may also need to go to the bathroom many times during the day. Many experts agree that going to the bathroom more than 8 times in 24 hours is “frequent urination.”

OAB Impact

OAB can impact a person not only socially, but also medically. Affected people may shun social gatherings or even trips to the grocery store or mall for fear of embarrassment, inability to find a bathroom in time, fear of smell (if they are incontinent). Incontinence may cause skin infections.

Causes of OAB

The bladder and the brain are connected via nerves in the spinal cord. Your brain usually tells the bladder not to contract unless the bladder is full and it is socially acceptable. If the brain gets wrong signals from the bladder, or if the brain is damaged (such as after a stroke), it will cause the bladder to contract prematurely, causing the sensation of urgency, and possibly even leakage before making it to the bathroom. If someone has a spinal cord injury above the sacral level, the connection between the brain and the bladder is disrupted and the bladder starts contracting too early. Other neurological conditions such as Multiple Sclerosis and Parkinson’s can be associated with OAB.

Infections or inflammation of the bladder can cause OAB.

Often there is no specific cause. Aging puts one at risk for OAB. Most important is to know that there is treatment available. It is not an accepted part of aging.

Non-obstructive urinary retention

Also commonly known as lazy bladder, flaccid neurogenic bladder. In this case the bladder muscle does not contract adequately, and the person is unable to empty the bladder although there is no obstruction of the bladder outlet. There are multiple causes such as spinal cord injury and other neurological conditions such as Multiple Sclerosis. Other causes can be bladder nerve damage due to pelvic surgery and bad urination habits.

Treatment for Overactive Bladder

At the time of visit your physician will perform a thorough history and physical to evaluate for OAB, and find a possible cause. He/She may also order some tests to confirm the diagnosis such as urinalysis, post void residual, urodynamics and a voiding diary. Once the diagnosis is confirmed, he or she will discuss life style changes, exercises, and possibly medications.

If those are not effective, or cause side effects, options such as Peripheral Tibial Nerve Stimulation (PTNS), Sacral Nerve Modulation (Interstim Therapy), and Botox injection will be discussed. All these have their pros and cons and these will be presented to you so that you may make an informed decision. Dr. Lotenfoe is fully qualified and experienced to perform these procedures.

A brief word on Sacral Nerve Modulation (Interstim therapy): Initially only a test is performed to see if you have a good result. A small electrode is placed next to the nerve controlling the bladder. This procedure is done outpatient under local anesthesia. There will be test period of usually a week or so where the electrode will induce tiny electrical pulses to the nerve. If you have a good result, a small electronic device is implanted under the skin for continued modulation. Dr. Lotenfoe has performed many of these procedures over the years with high success rates.

Treatment for non-obstructive urinary retention

There is no specific medication for this type of neurogenic bladder. Sometimes one can try a medication called bethanechol. but it rarely helps. Patients may be instructed to start self, intermittent catheterization, or even have a catheter permanently placed in the urethra and bladder. However, sometimes Sacral Nerve Modulation (Interstim therapy) may be effective.

Fecal Incontinence (FI)

Fecal incontinence and bowel control problems prevent you from controlling when and how often you have a bowel movement. You may experience unexpected small or large leaks of stools, may fail to reach the toilet in time, or not feel the urge to go to the toilet. Some people experience a combination of these symptoms. It is more common than one would think. As many as one in ten people have experienced bowel incontinence at one point in their lives.

Treatment consists of dietary modifications, bowel training and biofeedback, medications, and even major surgical interventions. A very effective way of treating fecal incontinence is Sacral Nerve Modulation (Interstim therapy), which Dr. Lotenfoe is very experienced in.

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