the basics

things you need to know about urinary incontinence.

There's a HUGE psychogenic/anxiety driven component,.  Fear of wetting leads patients to avoid outdoor exercise and social engagement. Cognitive therapy can help put worries in perspective.  Few causes of incontinence are easily cured.  A candidate for Botox, surgery or a nerve stimulator may enjoy many years of carefree life.  Most women will manage with briefs, kegels and adhering to a timed voiding schedule.

Before your exam you'll be asked to keep an intake/output diary as a way to help you pay attention to the signals your body gives you.

Workup starts with history, physical examination, and urinalysis.

Urodynamics are then gold standard for differencing types of incontinence.  They're tedious and quite uncomfortable,

Surgical interventions include sling surgery, mesh implants {many led to lifelong complications and misery}, and injection of bulking agents, which is generally successful,

Meds:
Anticholinergic drugs block the action of the chemical messenger acetylcholine. Acetylcholine sends signals to your brain that trigger bladder contractions associated with an overactive bladder. These bladder contractions can cause a need to urinate even when the bladder isn't full.

Anticholinergic medications include:

• Oxybutynin (Ditropan XL, Oxytrol, Gelnique)

• Tolterodine (Detrol, Detrol LA)

• Darifenacin

• Solifenacin (Vesicare, Vesicare LS)

• Trospium

• Fesoterodine (Toviaz)

They're often poorly tolerated and paradoxically cause many patients to guzzle water

Anticholinergics have been used in the treatment of overactive bladder (OAB), but their use is limited by poor tolerability and anticholinergic-related side effects. Increasingly, providers are discontinuing anticholinergic prescribing because of growing evidence of the association of anticholinergic use with increased risk of cognitive decline and other adverse effects.