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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20140
Experience:  I am fellowship trained specializing in general urology and reconstructive urology.
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What is suggested treatment for urge incontinence? Yes, no

Customer Question

What is suggested treatment for urge incontinence?
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: Yes, no medication suggested
JA: Anything else in your medical history you think the doctor should know?
Customer: I am 86, and have been very healthy. Have always had an annual physical.
Submitted: 6 months ago.
Category: Urology
Expert:  Dr. Captain replied 6 months ago.


Welcome to the question/answer interface.

I am a Family Medicine doctor, board certified, licensed and certified in Internal Medicine, Pediatrics, Obstetrics and Gynecology, as well as Integrative Medicine & Naturopathy. I have advanced training in Neurology, Cardiovascular Medicine, Gastroenterology, Endocrinology, and Psychiatry. I am also well-trained in Functional Medicine.

Thank you for the question, and giving me the opportunity to help you.

I am reviewing your question now and I will post back to you momentarily with your reply. It does occasionally take a short while for the responses to load. I thank you for your patience with our system.

Expert:  Dr. Captain replied 6 months ago.

What is urinary incontinence? — "Urinary incontinence" is the term doctors use when a person leaks urine or loses bladder control. Incontinence is a very common problem, but it is not a normal part of aging. If you have urinary incontinence, you do not have to "just live with it." There are treatments and things you can do on your own to stop or reduce urine leaks.

What are the symptoms of urinary incontinence? — There are different types of urinary incontinence. Each causes different symptoms. In men, the 4 main types are:

Stress incontinence – Men with stress incontinence leak urine when they laugh, cough, sneeze or do anything that "stresses" the belly. Some men get this type of incontinence after having surgery for prostate disease.

Urgency incontinence – Men with urgency incontinence feel a strong need to urinate all of a sudden. Urgency incontinence is also known as urge incontinence. Often the "urge" is so strong that they can't make it to the bathroom in time. (If you have these sudden urges but do not leak urine, you might have an "overactive bladder." That can also be treated.)

Expert:  Dr. Captain replied 6 months ago.

Mixed incontinence – Men with mixed incontinence have symptoms of both stress and urgency incontinence.

Incontinence caused by incomplete bladder emptying – Some men cannot fully empty their bladder when they urinate. This can happen if they have a condition called "benign prostatic hyperplasia," which makes the prostate grow larger than normal. An enlarged prostate can block the flow of urine.

Is there anything I can do on my own to feel better? — Yes. Here are some steps that can help reduce urine leaks:

Reduce the amount of liquid you drink, especially a few hours before bed.

Cut down on any foods or drinks that make your symptoms worse. Some people find that alcohol, caffeine, or spicy or acidic foods irritate the bladder.

Expert:  Dr. Captain replied 6 months ago.

Lose weight, if you are overweight.

If you have diabetes, keep your blood sugar as close to normal as possible.

If you take medicines called diuretics, keep in mind that these medicines increase the need to urinate. Try to plan ahead and take them when you know you will be near a bathroom for a few hours. If you keep having problems with leaking because of diuretics, ask your doctor if you can take a lower dose or switch to a different medicine.

These techniques can also help with bladder control:

Bladder retraining – During bladder retraining, you "train" yourself to go to the bathroom only at scheduled times. For instance, you might decide that you will go every hour. In that case, you would make yourself go every hour, even if you didn't feel the need to go. You would also try to wait until a whole hour had passed even if you needed to go sooner. Then, once you got used to going every hour, you would try to wait longer than an hour between bathroom visits. Over time, you might be able to "retrain" your bladder to wait 3 or 4 hours between bathroom visits.

Expert:  Dr. Captain replied 6 months ago.

Pelvic muscle exercises – Pelvic muscle exercises strengthen the muscles that control the flow of urine. When done right, these exercises can help. But people often do them wrong. Ask your doctor or nurse how to do them right.

Should I see my doctor or nurse? — Yes. Your doctor or nurse can find out what might be causing your incontinence. He or she can also suggest ways to help the problem.

Ask your doctor or nurse if any of the medicines you take could be causing your symptoms. Some medicines can cause incontinence or make symptoms worse.

How is incontinence treated? — Your treatment options depend on what type of incontinence you have. Some of the treatment options include:

Medicines to relax the bladder – These medicines can help with urgency incontinence.

Medicines to improve urine flow – These medicines can help with incontinence related to an enlarged prostate.

Expert:  Dr. Captain replied 6 months ago.

Repair the tissues that support the bladder or hold it in place

Improve the flow of urine, for example by removing part of the prostate gland

Repair the muscles that control urine flow

Electrical stimulation of the nerves that relax the bladder

Devices, such as:

A "condom catheter," which fits over the penis like a condom and collects urine into a bag that is strapped to the leg.

A penis clamp, which squeezes the penis to keep urine from leaking out (this can be used only for a certain amount of time).

What will my life be like? — Many men with incontinence can recover bladder control or at least reduce the amount of leakage they have. The key is to speak up about it to your doctor or nurse. Then work with him or her to find a treatment or therapy that helps you. Sometimes it takes a few tries before you find a solution, but the effort is worth it.

Expert:  Dr. Captain replied 6 months ago.

This is the current Uptodate information about urge incontinence.

Expert:  Dr. Captain replied 6 months ago.

The prevalence of urinary incontinence in men is approximately half that of women. Although men may experience significant emotional and social impact on quality of life, incontinent men are half as likely as women to seek care for urinary incontinence.

Men who have risk factors for urinary incontinence (advanced age, prostate disease, history of urinary tract infections, physical limitations, neurologic disease, constipation, depression, or diabetes) should be asked if they have had episodes of incontinence.

A history, physical examination, and urinalysis are sufficient to guide initial therapy. Men with "complicated" urinary incontinence should be referred to an urologist. Complicated urinary incontinence includes those with prior pelvic radiation or surgery, pelvic pain, severe incontinence symptoms, severe lower urinary tract symptoms, recurrent urologic infections, neurologic disease, abnormal prostate examination, hematuria, or elevated prostate specific antigen.

Expert:  Dr. Captain replied 6 months ago.

A multicomponent approach focused on the patient's most bothersome aspects of urinary incontinence is important for successful management. Treatment should start with the least invasive therapies, which include weight loss, dietary changes, pelvic floor muscle exercises, and medications. Contributory factors such as comorbid conditions and functional impairment should be corrected when possible, especially in older patients.

In patients with urgency incontinence who do not respond to lifestyle interventions or pelvic floor muscle exercise, we recommend treatment with either an alpha blocker or antimuscarinic medication (Grade 1B). Because of fewer adverse effects, we suggest initiating treatment with an alpha blocker rather than an antimuscarinic medication (Grade 2B).

Expert:  Dr. Captain replied 6 months ago.

If urgency incontinence symptoms persist despite adequate titration of alpha blocker therapy, we suggest addition of an antimuscarinic medication (Grade 2B).

In patients with stress incontinence who do not respond to pelvic floor muscle exercise, we suggest the addition of duloxetine

Surgical treatments for urinary incontinence are reserved for patients who do not respond to medical management. Sacral nerve stimulation, botulinum toxin injections, and augmentation cystoplasty are used for treatment of urgency incontinence. Transurethral bulking agent injections, perineal slings, and artificial urinary sphincters are used to treat stress incontinence.