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Urinary incontinence: More comfort for an uncomfortable problem by Susan Kammeraad-Campbell  Director of Publications, Marketing  Urinary incontinence. It's not the kind of thing people like to talk about. But for the millions of Americans who suffer from an inability to control their urination, it can have a devastating impact on their lives. Reports vary on how many Americans suffer from continence problems. Conservative figures indicate that 15 to 30 percent of adults and at least half of those in nursing homes have the condition. Many conditions and disorders can contribute to incontinence, including birth defects, pelvic surgery, injuries, multiple sclerosis, infection, neurological diseases and childbirth. While incontinence can affect children and young adults, it is more likely to afflict the elderly. Women are twice as likely to have problems as men. If you or a loved one suffers from incontinence, many treatments exist to control and/or cure the problem. “You'd be surprised how many people don't equate consuming liquids to frequent urination,” said Ross Rames, M.D., a urologist who specializes in the treatment of incontinence. The cure for that is easy. Regulate your intake of liquids. But for many people, the condition requires more aggressive intervention. Rames recommends a conservative treatment plan, before any surgical options are sought. “The less that needs to be done to a patient to see results, the better,” he said.  There are four major approaches to treatment: behavior changes, including exercises; medication; equipment; and surgery. Behavior techniques Exercise can involve biofeedback therapy, weight training, and pelvic floor stimulation. For women, daily Kegel exercises, which strengthen the pelvic floor muscles, in combination with an overall behavioral therapy program have been proven effective in more than half the women with the condition. Behavioral techniques can include scheduled toileting, where the incontinent patient uses the bathroom every two to four hours. Bladder retraining involves a regular toileting schedule that is modified over time, increasing the length of time between visits to the bathroom. Medications Physicians can prescribe medications to help control incontinence or can evaluate and/or modify other drugs the patient is taking to see if that might be the source of the problem. Equipment Many devices and products exist to help manage incontinence such as catheters, pelvic organ support devices, external collections systems, penile compression devices, absorbent products and undergarments. Surgical treatment Rames recommends that all appropriate non surgical treatments be tried before surgery is pursued.  A number of surgical procedures exists to treat incontinence such as sling procedures, bladder neck suspension, collagen injections around the urethra, implantation of all artificial urinary sphincter or sacral nerve stimulator. Electrostimulation: When nothing else works, there's still hope MUSC urologist Ross Rames, M.D., sees electrostimulation as a new branch of medicine. For those with continence problems who have been helped by the procedure, electrostimulation is nothing less than a saving grace. Rames is one of few physicians in South Carolina with the special training to surgically implant electro-stimulators in those suffering from incontinence. He trained with one of the pioneers who developed the procedure. “Usually when a patient comes to me, they have exhausted all other options,” said Rames. “Medications have failed them, changes in diet, exercise and other surgeries have not made a significant difference.” The therapy uses mild electrical pulses to stimulate a nerve near the tailbone in the lower back. This nerve, called the sacral nerve, controls the bladder and sends signals to the brain to either control or relieve the bladder. When the communication between the sacral nerve and the brain is not working correctly, bladder control problems will happen. An electrostimulator works like a heart pacemaker regulating the flow of electrical currents, allowing the patient to exercise bladder control. A probe is inserted to connect with the sacral nerve at one end and with the test stimulator at the other. The patient wears the stimulator on his belt like a pager for a couple of weeks to see if the therapy is making a difference. If it does, a stimulator is implanted in the patient's side. The second procedure takes about an hour, and can be performed under local or general anesthetic. Most patients go home the same day. The success rate for the therapy, which has been available for about six years, is high. More than 75 percent are favorably effected. Half regain complete control as long as the stimulator is in place. For many patients who would otherwise face being catheterized for life, electrostimulation can make a world of difference. Editor's note: The article is reprinted from Checkup newsletter, produced by MUSC Creative Services.  Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. 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