Montclair Urological Group, P.A. a division of Urology Group of New Jersey (UGNJ)

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Expert Care for A Sensitive Problem

Learn more about urinary incontinence in the
Continence Center Glossary

If you or someone you know is affected by loss of bladder control, a medical condition called urinary incontinence, you are not alone.

More than 30 million Americans suffer from this condition, which causes involuntary leakage of urine.

That's why Dr. Konstantin Walmsley, a urologist fellowship-trained in female urology and voiding dysfunction at Columbia-Presbyterian Medical Center, created The New Jersey Continence Center at Montclair Urological Group. It is the comprehensive solution to an age-old problem.

Urinary incontinence affects both sexes, all ages, and people of all socioeconomic levels. It is estimated that 15 to 30 percent of people over 60 years of age have incontinence. Over thirteen million Americans have some form of incontinence. Nearly 85% of these people are women.

A number of factors may contribute to the problem including:

The most common types of incontinence are: stress incontinence, urge incontinence (often called overactive bladder), or a combination of both, called "mixed incontinence."

Some people manage to avoid urine loss by urinating frequently, but find the continual need to have a bathroom available restrictive to their lifestyles. This condition has received more media attention recently and is also called OVERACTIVE BLADDER. A normally functioning bladder can wait until the appropriate opportunity to empty--an overactive bladder can not.

Overactive bladder is a condition that affects upward of 33 million Americans. It is a syndrome in which patients complain of several symptoms including urinary frequency, urinary urgency, and nocturia (waking up one or more times at night to urinate). About 1/3 of patients with overactive bladder have incontinence as well. Overactive bladder is best treated with a combination of bladder training and medical therapies.

Urinary incontinence includes a spectrum of disorders ranging from simple stress incontinence to bladder instability (overactive bladder) to neurological disorders. Treatment can range from behavioral therapy to medication to surgery, either alone or in combination.

Behavioral therapy includes fluid management, bladder training, and pelvic muscle exercises. Advantages of behavioral therapy are that they are safe, effective, and have no documented side effects.

Many patients are unaware of what or how much they drink. A voiding diary can be used to accurately document drinking and voiding habits. Fluid management may consist of monitoring/controlling amount of water intake and decreasing dietary bladder irritants, such as caffeine.

Bladder training also involves the use of a voiding diary. By seeing how often voiding and incontinence occurs, the use of timed voiding patterns can avoid incontinent episodes. Also, by slowly increasing the interval between voids, the bladder can sometimes be retrained to increase functional capacity.

Pelvic muscle exercises improve urethral resistance and pelvic visceral support, as well as causing a reflex relaxation of the bladder. This may be done with or without biofeedback. Biofeedback is a form of learning in which the patient receives feedback in the form of visual, auditory, or tactile signals reinforcing appropriate pelvic muscle activity. When given verbal instructions alone, only 60 percent of patients are able to produce an appropriate pelvic floor contraction, and 25 percent have counterproductive Valsalva maneuver. Continence is achieved more rapidly with the assistance of biofeedback.

Stress Incontinence is urine loss that results from an increase in pressure in the abdomen, which momentarily places increased physical stress on the pelvis. Coughing, sneezing, laughing, exercise, lifting, and even standing up are activities that can cause urine loss in women with this type of incontinence.

Urge Incontinence is loss of urine that is associated with a sudden, strong desire to urinate, which cannot be postponed. People with urge incontinence may describe mounting pressure or sudden loss of urine in a rush to reach the toilet. This may commonly occur in association with certain triggering events, such as fumbling with the keys to open the front door, the sound or sensation of running water on the hands, or exposure to sudden cold. Other symptoms include a need to urinate frequently and waking often during the night to urinate.

Mixed Incontinence describes a combination of both stress and urge-type urinary incontinence symptoms. Usually, one type is more bothersome than the other. For example, a woman may most often have stress incontinence and only rarely be unable to reach the toilet in time. Sometimes, this may make a clinical diagnosis difficult, and further testing of bladder function may be necessary.

Incontinence is NOT a normal part of the aging process, and there are a variety of treatment options and strategies available.

We can help. The New Jersey Continence Center offers a comprehensive array of clinical services for women and men with incontinence, urethral or bladder dysfunction, and pelvic support problems.

Despite its prevalence, most people with incontinence are embarrassed or unaware that help is available. Many instead turn to diapers and absorbent pads, unnecessarily resigning themselves to living unhappily and uncomfortably with this debilitating yet very treatable problem. Studies have demonstrated that urinary incontinence is far more than a medical problem, often affecting the emotional, psychological, and social well-being of patients as well.

Today, more than ever before, help is readily available for people with urinary incontinence. It can be treated in the vast majority of cases, and the number of treatment options is growing. With proper diagnosis and treatment, most people with incontinence can be cured, if not improved.

The New Jersey Continence Center offers a variety of programs to diagnose the type of urinary incontinence a patient has, and the degree of severity, so the most effective treatment options can be explored.

Each new patient at the center receives an in-depth evaluation to determine if his or her incontinence is temporary and has a good chance of improving by itself, or if medical intervention is necessary.

The evaluation includes obtaining a thorough history that explores patient symptoms, including urgency, urination that occurs when abdominal muscles are exercised (while laughing, coughing or running, for example) and unusual frequency.

Medical problems, surgeries, and medications are also discussed, and a complete obstetric and gynecological history is obtained for women.

Some people manage to avoid urine loss by urinating frequently, but find the continual need to have a bathroom available restrictive to their lifestyles. This condition has received more media attention recently and is also called OVERACTIVE BLADDER. A normally functioning bladder can wait until the appropriate opportunity to empty--an overactive bladder can not.

Overactive bladder is a condition that affects upward of 33 million Americans. It is a syndrome in which patients complain of several symptoms including urinary frequency, urinary urgency, and nocturia (waking up one or more times at night to urinate). About 1/3 of patients with overactive bladder have incontinence as well. Overactive bladder is best treated with a combination of behavioral modification and medical therapies.

Behavioral therapy includes fluid management, bladder training, and pelvic muscle exercises. Advantages of behavioral therapy are that they are safe, effective, and have no documented side effects.

Many patients are unaware of what or how much they drink. A voiding diary can be used to accurately document drinking and voiding habits. Fluid management may consist of monitoring/controlling amount of water intake and decreasing dietary bladder irritants, such as caffeine.

Bladder training also involves the use of a voiding diary. By seeing how often voiding and incontinence occurs, the use of timed voiding patterns can avoid incontinent episodes. Also, by slowly increasing the interval between voids, the bladder can sometimes be retrained to increase functional capacity.

Pelvic muscle exercises improve urethral resistance and pelvic visceral support, as well as causing a reflex relaxation of the bladder. This may be done with or without biofeedback. Biofeedback is a form of learning in which the patient receives feedback in the form of visual, auditory, or tactile signals reinforcing appropriate pelvic muscle activity. When given verbal instructions alone, only 60 percent of patients are able to produce an appropriate pelvic floor contraction, and 25 percent have counterproductive Valsalva maneuver. Continence is achieved more rapidly with the assistance of biofeedback.

Don't ignore your urinary problems because of embarrassment or a feeling of helplessness. Let the staff at the New Jersey Continence Center help you with your problems in a compassionate, sensitive, and comprehensive fashion.

Learn more about urinary incontinence in the
Continence Center Glossary