Stress incontinence is a particular onset of incontinence, where physical activity causes the involuntary loss of bladder control. It doesn’t have any relation to stress psychologically.

Medical Cause

Stress incontinence happens because of the weakening of the muscles around the bladder to hold back urine. 

The urinary sphincter and other muscles around the pelvic floor can usually retain urine as the bladder expands. If they weaken, any pressure put on them with the exertion of the pelvic or even abdominal muscles will sometimes cause involuntary urination.

Symptoms

Certain large-scale activities like lifting heavy objects, exercising or even just bending over can make a person prone to loss of bladder control from stress incontinence. Involuntary actions like coughing, laughing or sneezing can also strain the pelvic floor muscles, leading to involuntary urination.  

These actions won’t always result in incontinence, especially if the bladder is empty. If you regularly urinate involuntarily, you should see a doctor.

Causes

There may be some physiological causes that are more likely to result in incontinence, including one’s advanced age or being overweight. 

Likewise, surgeries around one’s pelvis will weaken the surrounding muscles and pose a risk of bringing about incontinence. 

The increased risk is true for men, especially with enlarged prostates or after prostate surgery, or with women after they give birth via the birth canal. Moreover, women who gave birth with the help of forceps have a higher chance of incontinence, but not all other procedures will see this increased likelihood. 

Chronic coughing, or anything that will cause such coughing such as cigarette smoke, will also exacerbate incontinence because it strains the pelvic floor muscles in a frequent, harsh way. 

Associated Risks

Incontinence by itself can have lots of causes but is not usually harmful. It can, however, cause skin rashes or other irritation. That is bad for the skin, and you should treat it quickly. It may also be emotionally taxing. 

Solutions

If you’re concerned with instances of stress incontinence or have these symptoms, schedule an appointment now. Anyone in the Chattanooga area can reach out to UT Urology at 423-778-5910 or online at uturology.com.

Millions of women are affected by urinary incontinence at some point in their lives. This problem seems to most commonly affect women over the age of 50. Research has discovered several interesting facts about urinary incontinence. Perhaps the most fascinating one is that most women who experience symptoms of this condition never see a doctor to find out why or what they can do about it. Here, we discuss what urinary incontinence may look like, what women typically do to help themselves, and what they might do instead.

Symptoms of Urinary Incontinence

It’s easy to assume that urinary incontinence causes a single symptom: accidental urine leakage. This is true in the bigger picture but there are nuances depending on the type of urinary incontinence a woman has.

• A woman with stress urinary incontinence will accidentally leak urine when she tries to exercise or when she laughs, coughs, sneezes, or performs any activity that may exert pressure on the abdomen.
• A woman with overflow incontinence may experience frequent dribbling of small amounts of urine. This happens because the bladder does not fully empty during urination.
• A woman with urge incontinence will feel a strong and sudden urge to urinate. She will leak urine before she makes it to the bathroom.
• Functional incontinence occurs when a person has a mental or physical impairment.
• A woman may also have mixed incontinence, which carries symptoms of more than one of the types we’ve mentioned here.

Common Approaches to Urinary Incontinence

Researchers at the University of Michigan Institute for Healthcare Policy and Innovation conducted a poll of over 1, 000 women aged 50 to 80. They discovered that:

• Less than half of all women who were living with urinary incontinence had seen a doctor to discuss their symptoms.
• Over 40% of women described their urinary leakage as a major problem.
• More than half of the women over age 65 had experienced urinary incontinence.
• 43% of women aged 50 to 65 had experienced symptoms.
• More than half of the women experiencing urinary incontinence managed their symptoms by wearing special pads or undergarments.
• 15% were strategic in how they dressed so accidental leaks could be hidden.

A Urologist Can Help

Urinary incontinence is not a simple matter of aging, vaginal atrophy, muscle weakness or weight. There may be several factors contributing to urine leakage. A urologist can help uncover the cause of urinary incontinence and find the right solution to improve quality of life. Learn more about treatments for urinary incontinence. Call our Chattanooga office at (423) 778-5910.

Many people blame their frequent visits to the bathroom every night on an overactive bladder (OAB) or, for men, an enlarged prostate. While these may be frequent causes of nocturia (waking up to urinate more than one time per night), an often overlooked cause is obstructive sleep apnea. If you wonder how sleep apnea could cause you get up multiple times at night to urinate, a recent study by Miyauchi et al  confirms both the relationship between nocturia and sleep apnea as well as the improvement seen with treatment.
We begin by noting that many patients who get up frequently at night do so because they make too much urine at night. The bladder is simply filling up more quickly than it should. Normally for young people, no more than 20% of your daily urine production should come while you are asleep. In older patients, less than 33% is more normal. Patients who exceed this are said to have nocturnal polyuria, meaning they make too much urine at night. This is easily diagnosed by having patients keep a diary for several nights to measure how much urine they make during the night compared to the day.

While there are several causes of nocturnal polyuria, an often overlooked one is obstructive sleep apnea. Blockage of your airway in sleep apnea results in a lot of negative pressure in the chest as you try to breathe (try closing your throat and taking a breath).  This causes more blood to return to the heart. When this part of the heart expands from the extra blood, it releases a hormone (atrial natriuretic peptide) that makes you make more urine. It’s as if the body thinks there is too much blood volume (maybe you drank a lot of fluid) and tries to get rid of the excess fluid. So, patients with obstructive sleep apnea make too much urine at night.

The encouraging news is that treatment of the sleep apnea such as with a mask providing continuous airway pressure (CPAP) not only treats the sleep apnea but also will reduce the urine production and the nocturia. So next time you find yourself getting up that 3^rd or 4^th time at night, consider having an evaluation of whether you are making too much urine at night. If so, a test for sleep apnea may be in order.

Colin M. Goudelocke, M.D.

If you are a coffee drinker and you suffer from symptoms of overactive bladder (OAB) such as frequent urination or urgent urination, it is a very safe bet that someone (very often your health care provider) has told you to cut out the caffeine. Caffeine can serve as both a stimulant, an irritant, and a diuretic so it should follow that it must lead to overactive bladder, right? That has been the conventional wisdom for years, though we should always be careful to check that our wisdom is really based on facts.

A recent review article by Palma and Staak provides an overview of the most recent studies about the effects of caffeine on the bladder. When taken together, these studies demonstrate that drinking more than 2 cups of coffee per day (>200mg caffeine) is associated with worsening symptoms of overactive bladder. The effect does depend on the dose and more than 4 cups of coffee per day may result in developing symptoms of OAB even in patients with no symptoms before.

One bit of good news is that the small amount of caffeine found in decaffeinated coffee does not appear to have a negative effect on OAB symptoms.

In this case, the conventional wisdom, dispensed for years by friends, family and even your health care provider appears to be spot on. You may want to skip that extra cup of coffee tomorrow if you have a long meeting in the morning.

Colin M. Goudelocke, M.D.

Historically, management of overactive bladder (OAB) can be seen to have failed to fully address the needs of patients. A majority of patients with OAB report their symptoms have a significant impact on daily living and seek medical help. Yet in at least







one study (which, is, admittedly, more than 15 years old) only about 1/4 of those patients were receiving treatment at the time evaluated. Half of those patients who did not seek treatment believed that no treatment was available. Furthermore, we know that a significant number of people will fail to see satisfactory improvement with early therapies including behavioral changes and medications.  Few of these people are treated with more advanced therapies intended for those patients patients with these refractory symptoms.

A care pathway is a set of steps designed to effectively manage a patient’s journey from disease to health. It is essentially a “roadmap” of how we believe a patient should be diagnosed and treated for a given problem.

It provides a standard set of instructions as to how we should care for patients and should be based on the most current guidelines and evidence available. It would seem logical that an optimized patient care pathway for OAB should lead to better outcomes. Furthermore, illustrating the care pathway in a way patients can see and understand (we use a “roadmap”) can help patients to see what to expect as they undergo evaluation and treatment.

In developing our OAB Care Pathway, we first sought to define what the initial steps should be in evaluating patients thought to have OAB. The initial evaluation of OAB begins with a thorough, but otherwise simple evaluation including a history of symptoms and other medical problems, as well as a physical exam designed to identify any other conditions that may mimic OAB. It is clear that for most patients with OAB, expensive and invasive tests are not needed for the evaluation.

An OAB Care Pathway should define the appropriate therapies for treating OAB. This includes behavioral changes, oral and dermal medications, percutaneous tibial nerve stimulation, sacral neuromodulation, and botulinum toxin. An optimized pathway considers not just what treatments can be used but the ideal order for those treatments. In the case of OAB, you would not want to begin with a treatment such as sacral neuromodulation before trying a more conservative therapy such as behavioral changes or medications. Again, consultation with available guidelines is helpful in defining which therapies are appropriate and when they should be used.

It is important for patients to have an idea of how long they should expect before a treatment begins to work. We use “mile markers” along the way so that patients can anticipate how long before they may see improvement.

A care pathway does little good if patients are blocked from making progress by barriers such as treatment side effects, problems with insurance coverage, or need for more advanced testing. In The OAB Clinic, an OAB Navigator assigned to each patient serves as a guide along the journey. She can help patients get back on track by answering questions, helping to facilitate medication changes, or arranging ahead of time for any needed tests. This helps to decrease the need for frequent visits, eliminating many of the “stops” along the way.

In The OAB Clinic, a part of UT Erlanger Urology in Chattanooga, Tennessee, our use of an optimized Patient Care Pathway has helped to significantly reduce those patients who leave the road to bladder health because of confusion or frustration. We have seen the number of patients “lost” plummet from about 70% to about 7%. This means that more patients are able to reach their bladder goals. With our care pathway, we hope to continue to change the history of OAB for all.

Colin M. Goudelocke M.D.  FPMRS

The OAB Navigator at The OAB Clinic in Chattanooga, Tennessee, serves a very unique and important role in the care of our incontinence patients. But before we describe that role, it may be helpful to first describe the obstacles many of our Overactive Bladder (OAB) patients faced before the arrival of our navigator. Only by seeing how far we have come are we able to appreciate how critical a role the OAB Navigator plays in the success of our patients.

Not so long ago, the majority of our OAB patients were frustrated by the obstacles they faced in seeking and receiving treatment for their bladder symptoms. One example I use frequently is the patient who might come back to clinic several weeks after starting a new medication. Some of those patients might return to tell us that they had stopped the new treatment due to side effects – sometimes only days after starting it. Think of the frustration of sitting at home for weeks without any treatment, waiting for your appointment so that you can tell us that the treatment we prescribed made you worse, not better. And for this privilege you often paid yet another co-pay! This kind of wasteful back and forth was standard before our OAB Navigator.

Today, that patient with intolerable side effects (and every other patient) receives a phone call about a week later from the navigator. If a different medication is needed or questions about side effects need to be answered, this is usually handled over the phone without the need for another visit (and another co-pay!). After 3-4 weeks, another phone call assesses how patients are responding to therapy. If changes need to be made, this can be done, again, by phone. It also allows us to anticipate your needs at the next visit, scheduling additional time or testing as needed.

The use of an OAB Navigator, has allowed us at The OAB Clinic to minimize the number of visits needed for you to reach your bladder goals. Through the navigator, we try to answer your questions when you have them, not weeks later at your next visit. OAB patients calling in with questions or concerns can directly reach the navigator, their own personal “concierge” through the journey to bladder health. Finally, the navigator allows us to anticipate your needs before your visit, so we can be prepared before you come. In one phrase: it allows us to be proactive not reactive.

Our OAB Navigator is one of the many ways we are striving at The OAB Clinic to provide the very best care for urinary incontinence. As a part of UT Erlanger Urology in Chattanooga, Tennessee, we are able to provide all of the resources that may be needed to care for urinary incontinence, no matter how complex. Please visit us or call at (423) 778-4OAB (4622) if we can help.

Colin M. Goudelocke, M.D.  FPMRS

These three simple and quick incontinence questions, based on the 3IQ incontinence questionnaire, can be very useful in helping you determine what type of incontinence you may be experiencing.

1. During the last 3 months, have you leaked urine (even a small amount)?

Urinary incontinence can be determined by simply asking someone if they ever experience urine leakage that is unintentional. Yet this ignores the fact that it is possible to experience occasional urinary leakage that may be infrequent enough that it is not bothersome. It may be more helpful to describe urinary incontinence as “the involuntary loss of urine” that poses a “social or hygienic problem”. For many patients with urine leakage, incontinence does represent a severe and bothersome stress that has social, financial and psychological consequences.

2. During what kinds of situations did you leak urine?

Beyond simply determining if urine leakage is bothersome, it is important to determine what type of incontinence you are experiencing. Urine leakage can occur in association with physical activity including coughing, sneezing, laughing, exercise or bending over. This is often referred to as Stress Incontinence. The “stress” refers to the increase in the pressure in your abdomen that results in the leakage.

In other patients, a sense of urgency (a sudden urge to urinate that is difficult to postpone) accompanies urinary leakage. Patients with Urgency Incontinence will often urinate frequently and urgently as well, trying to prevent urinary leakage.

Finally, patients may also experience loss of urine without either any exertion or sense of urgency.

3. During what kinds of situations did you leak urine most often?

While we generally describe urinary incontinence as being either Stress Incontinence or Urgency Incontinence, this does not mean that all patients will have either Urgency Incontinence OR Stress Incontinence. In fact, about 40% of patients (and the number may be much higher) with incontinence will experience both Stress Incontinence AND Urgency Incontinence to some degree. This is usually referred to as Mixed Incontinence.

But for many patients, it is useful to determine if either Stress Incontinence or Urgency Incontinence predominates, even if they experience both types. This allows us to focus on what is the more bothersome form of incontinence. It is not unusual for a patient to see improvement in one type of incontinence, only to realize that they have relatively little bother from the other type and do not need further therapy.

In those patients who do not find a connection between urine leakage and either coughing, sneezing, etc, or urgency, there may be another cause of incontinence (neurologic injury, fistula, etc) that needs to be investigated by a specialist in the field.

With three simple questions, patients can often, reliably, identify they type of incontinence they are experiencing. This is useful in guiding both an evaluation of the urine leakage as well as possible therapies available.

At The Overactive Bladder Clinic a part of UT Erlanger Urology in Chattanooga, Tennessee, we specialize in the evaluation and treatment of all forms of urinary incontinence. For more information, contact us at 423-778-4OAB (4622).

Colin M. Goudelocke, M.D.  FPMRS

Urinary Incontinence is quite common with 38% of women and 9% of men reporting at least one episode of urinary incontinence (unplanned loss of urine). But what exactly is the cause of this urine leakage and how can you tell if Overactive Bladder (OAB) is the cause of your incontinence?

OAB is usually characterized by a sudden urge to urinate that is difficult to control (urinary urgency).  People with OAB may also report urinary frequency  (urinating more than 8 times per day is usually considered abnormal). They may be bothered by nocturia (getting up more than 1 time at night). About 2/3 of patients with OAB will also experience urgency incontinence (urine leakage associated with urgency).  Not all people with OAB experience leakage and the leakage may be a small or very large amount.

But OAB and urgency incontinence are different from another common type of urine leakage called stress incontinence. In stress incontinence (SUI), people leak with coughing, laughing, sneezing, lifting or other exertional activities. This is caused by a weakness in the muscles that support the bladder and urethra. It is important to know that many people experience both types of incontinence.

One of the best ways to distinguish between these types of urine leakage is to complete a voiding diary. This is a 1 or 3 day record of how often you urinate and what you may be doing during episodes of leakage. Not only is this helpful but it is extremely easy and inexpensive.

Of course, there are some other conditions, some quite concerning, that can mimic the symptoms of overactive bladder. Among these are kidney stones, bladder tumors and complications from previous surgeries. This is why it can be helpful to meet with a health care provider to review your history and discuss treatment options.

Overactive Bladder (OAB) is a common problem that can have an immense impact on the lives of men and women. However, identification of this disorder is often simple and straightforward and can lead to tremendous improvement in your quality of life. Don’t let fear or embarrassment keep you from taking back control!

-Colin M. Goudelocke, MD, FPMRS