Gotta Go? Gotta Go! Gotta Go? Gotta Go! Gotta GO!!!Gotta GO!!!

Discussion of Urinary and Fecal Discussion of Urinary and Fecal Urgency, Frequency, and Urgency, Frequency, and

IncontinenceIncontinence

Elizabeth Babin, MDElizabeth Babin, MD

Female Pelvic Medicine and Reconstructive SurgeonFemale Pelvic Medicine and Reconstructive Surgeon

Director, Athena Women’s Institute for Pelvic HealthDirector, Athena Women’s Institute for Pelvic Health

Professor Drexel University Department of Professor Drexel University Department of UrogynecologyUrogynecology

Select the most appropriate Select the most appropriate subtitle for this talksubtitle for this talk

A: Bladders gone wild!A: Bladders gone wild!B: There’s no such thing as bad bladders, they B: There’s no such thing as bad bladders, they

just do bad things…just do bad things…C: Your system software has been corrupted. C: Your system software has been corrupted.

Do you have the right driver installed for that Do you have the right driver installed for that bladder?bladder?

D: I’m going to go crazy if I have to find another D: I’m going to go crazy if I have to find another pottypotty

Learning ObjectivesLearning Objectives

Review definition, causes, and treatments Review definition, causes, and treatments for:for: urinary urgency, frequency, and urinary urinary urgency, frequency, and urinary

incontinenceincontinence recurrent urinary tract infectionsrecurrent urinary tract infections fecal incontinencefecal incontinence

General DefinitionsGeneral Definitions

Urgency: sudden compelling sensation to pass urine or Urgency: sudden compelling sensation to pass urine or feces which is difficult to defer feces which is difficult to defer ““Gotta Go”Gotta Go” Primary symptomPrimary symptom of overactive bladder or bowelof overactive bladder or bowel

Frequency: excessive number of voids or movements Frequency: excessive number of voids or movements over a 24 hour periodover a 24 hour period

Urinary Incontinence: involuntary loss of urineUrinary Incontinence: involuntary loss of urine Fecal Incontinence: involuntary loss of gas or fecesFecal Incontinence: involuntary loss of gas or feces Recurrent Urinary Tract Infections (UTIs): >2 bladder Recurrent Urinary Tract Infections (UTIs): >2 bladder

infections proven by urine culture in a 6 months periodinfections proven by urine culture in a 6 months period

Incontinence is a Incontinence is a Common ProblemCommon Problem

1:3 women over age 451:3 women over age 45

Which is over 13 million womenWhich is over 13 million women

1:2 women over age 651:2 women over age 65

Anatomy ReviewAnatomy ReviewBladder: stores Bladder: stores urineurineUrethra: tube that Urethra: tube that allows urine to passallows urine to passUrethral sphincter: Urethral sphincter: muscle surrounding muscle surrounding the urethra that hold the urethra that hold the urinethe urineBrain signals are Brain signals are key to coordinating key to coordinating the function of these the function of these anatomical structuresanatomical structures

Anatomy ReviewAnatomy Review

What is Overactive Bladder? What is Overactive Bladder? It is a combination of symptoms that may or may not It is a combination of symptoms that may or may not

include involuntary loss of urine that are the result of include involuntary loss of urine that are the result of the brain miscommunicating with the bladder (nerve the brain miscommunicating with the bladder (nerve inputs leading to abnormal sensations and/or muscle inputs leading to abnormal sensations and/or muscle reactions)reactions) UrgencyUrgency FrequencyFrequency LeakageLeakage ““I get an urge to urinate that causes me to frequently I get an urge to urinate that causes me to frequently

search for the bathroom and sometimes I don’t make it!” search for the bathroom and sometimes I don’t make it!” Gotta go!!Gotta go!!

OAB TreatmentsOAB Treatments

Behavioral ModificationBehavioral Modification Lifestyle changes, dietary avoidance, timed Lifestyle changes, dietary avoidance, timed

voidingvoiding Biofeedback/Pelvic Floor RehabilitationBiofeedback/Pelvic Floor Rehabilitation MedicationsMedications Neural stimulationNeural stimulation BotoxBotox

Interstim Nerve StimulatorInterstim Nerve Stimulator

What is Stress Incontinence?What is Stress Incontinence?

Loss of urine with Loss of urine with anything that increases anything that increases the pressure on the the pressure on the bladder that overcomes bladder that overcomes the urethral sphincterthe urethral sphincter

CoughCough SneezeSneeze ExerciseExercise LaughLaugh

What Causes Female SUIWhat Causes Female SUI

Hypermobile urethra – Hypermobile urethra –

descentdescent Inadequate urethral Inadequate urethral

sphinctersphincter

These are resulting fromThese are resulting from

Birth, trauma, surgery, Birth, trauma, surgery, radiation, hormonal radiation, hormonal changes, muscle changes, muscle deteriorationdeterioration

SUI TreatmentsSUI Treatments Goal: To strengthen or support the damaged Goal: To strengthen or support the damaged

pelvic floor muscles pelvic floor muscles

Pelvic floor excercisesPelvic floor excercises Pessaries or Urethral PlugsPessaries or Urethral Plugs Bulking agentsBulking agents Minimally Invasive SurgeryMinimally Invasive Surgery

*There are no medications at this point*There are no medications at this point

FemSoftFemSoft Insert Function Insert Function Disposable, Single-Use Disposable, Single-Use

DeviceDevice

Placed in a Woman’s Urethra Placed in a Woman’s Urethra to Prevent Accidental to Prevent Accidental LeakageLeakage

Soft Sleeve Conforms to the Soft Sleeve Conforms to the Urethra and Bladder NeckUrethra and Bladder Neck

Bulking AgentsBulking Agents

SlingsSlings

90% success rate90% success rate Minimally invasiveMinimally invasive OutpatientOutpatient Quick recovery 3-4 Quick recovery 3-4

days days

What is Mixed Incontinence?What is Mixed Incontinence?

The combination of both stress and urge The combination of both stress and urge incontinence.incontinence.

Therapy focuses on the most bothersome Therapy focuses on the most bothersome symptom and usually requires both symptom and usually requires both nonsurgical and surgical treatment.nonsurgical and surgical treatment.

Recurrent UTIsRecurrent UTIs

20% of women who have a UTI will have 20% of women who have a UTI will have anotheranother

30% if you have had 230% if you have had 2 80% if you have had >280% if you have had >2

Defined as at least 2 culture documented Defined as at least 2 culture documented infections in 6 months or 3 in 12 monthsinfections in 6 months or 3 in 12 months

Why do I always get bladder Why do I always get bladder infections?infections?

Hormone deficiencyHormone deficiency DiabetesDiabetes Incomplete bladder emptying either from weak Incomplete bladder emptying either from weak

bladder muscle or partial obstruction from bladder muscle or partial obstruction from prolapseprolapse

Bladder stones or massesBladder stones or masses Incomplete initial treatment or bacterial Incomplete initial treatment or bacterial

resistanceresistance IntercourseIntercourse

How do I get rid of the darn How do I get rid of the darn things?things?

Always get a urine culture and antibiotic Always get a urine culture and antibiotic sensitivity when symptoms occursensitivity when symptoms occur

Have a physical exam and cystoscopy to Have a physical exam and cystoscopy to ensure no anatomical reasonsensure no anatomical reasons

Treatments:Treatments: Low dose daily antibiotic for at least 6 monthsLow dose daily antibiotic for at least 6 months Single antibiotic dose with each intercourseSingle antibiotic dose with each intercourse Hormone supplementationHormone supplementation

Recurrent UTI preventionRecurrent UTI prevention

Drink plenty of water to avoid concentrating any Drink plenty of water to avoid concentrating any small bacteria in urinesmall bacteria in urine

Wipe front to back to avoid anal bacterial Wipe front to back to avoid anal bacterial contaminationcontamination

Take showers instead of bathsTake showers instead of baths Cleanse genital area after intercourseCleanse genital area after intercourse Avoid douches and feminine hygiene sprayAvoid douches and feminine hygiene spray Drink Cranberry JuiceDrink Cranberry Juice

Fecal IncontinenceFecal Incontinence

Inability to control your bowelsInability to control your bowels Either leakage with urge or unexpectedEither leakage with urge or unexpected

6.5 million Americans 6.5 million Americans Not a normal part of AgingNot a normal part of Aging

Anatomy Rectum and AnusAnatomy Rectum and Anus

What causes Fecal What causes Fecal Incontinence?Incontinence?

Childbirth/trauma/Childbirth/trauma/surgery may damage surgery may damage the sphincter or the the sphincter or the nerve innervationnerve innervation

Loss of storage Loss of storage capacity in the rectumcapacity in the rectum

Diarrhea or loss of Diarrhea or loss of bulkingbulking

Pelvic floor Pelvic floor dysfunctiondysfunction

Non-surgical managementNon-surgical management Dietary changesDietary changes

Fiber supplementationFiber supplementation Drink lots of waterDrink lots of water Avoid foods which exacerbate IBS or diarrhea statesAvoid foods which exacerbate IBS or diarrhea states

• Caffeine, spice, cured meat, grease, artificial Caffeine, spice, cured meat, grease, artificial sweetners sweetners

Bowel managementBowel management Planned defectation (timing, use of gastrocolic reflex)Planned defectation (timing, use of gastrocolic reflex) EnemasEnemas

Non-surgical managementNon-surgical management

Pharmacologic interventionsPharmacologic interventions Steroids and sulfasalazine for UCSteroids and sulfasalazine for UC Steroid enemas for radiation proctitisSteroid enemas for radiation proctitis Cholestyramine for diarrhea from malabsorption Cholestyramine for diarrhea from malabsorption

of bile saltsof bile salts Motility agents:Motility agents:

Loperamide (Imodium) Loperamide (Imodium) Lomotil (atropine/diphenoxylate)Lomotil (atropine/diphenoxylate)

Non-surgical managementNon-surgical management

Perineal exercises to strengthen musclesPerineal exercises to strengthen muscles Anal PlugAnal Plug BiofeedbackBiofeedback

Sensory trainingSensory training Muscle trainingMuscle training Cure or improvement in 70-80%Cure or improvement in 70-80% Results tend to be long-lastingResults tend to be long-lasting

Surgical ProceduresSurgical Procedures

SphincteroplastySphincteroplasty Prolapse RepairProlapse Repair Artificial Anal Artificial Anal

SphincterSphincter Bulking agentBulking agent Radio-Frequency Radio-Frequency Sacral Nerve Sacral Nerve

StimulationStimulation ColostomyColostomy

ConclusionConclusion

Bladder and Fecal Incontinence can rob Bladder and Fecal Incontinence can rob you of your life. Let us help you get your you of your life. Let us help you get your LIFE BACK!!LIFE BACK!!