Exceptional Parent - August 2009 - (Page 48) Incontinence Education Series – Part 7 Another minimally invasive treatment option for stress incontinence involves injection of a bulking agent, most often collagen, under the lining tissues of the urethra at the bladder neck. continued from page 47 computer regarding strength and time of muscle contractions. This can improve exercise efficiency and may enhance outcomes of pelvic floor muscle exercises for some patients. • Absorbent Pads and Products – There are a wide variety of absorbent pads and products on the market to help with incontinence symptoms in both men and women. These are not to be considered ‘cures,’ and most people should be encouraged to seek evaluation and treatment for their incontinence. In most cases, other therapies can reduce or eliminate the problem. However, absorbent pads can be useful to allow people with incontinence to better manage their symptoms, particularly when they want to engage in physical or social activities. SURGICAL THERAPIES A variety of surgical treatments have been developed to treat incontinence. It is important to identify the cause of symptoms because this will influence the types of surgery considered for a given patient. These techniques have undergone many refinements that have led to better success rates and improved outcomes. • Sling Procedures – Stress incontinence can be treated with placement of a sling either underneath the bladder neck or midurethra. These function like a small hammock to create enough resistance at the outlet of the bladder to keep urine from leaking when there is an increase in abdominal pressure. The graft for the sling can be created with either natural materials such as fascia, a dense connective tissue, or with artificial mesh. Overall success rates for slings in women are quite good, with up to 90% of patients initially reporting either no incontinence or significant improvement. Recent technical advances have also led to development of sling procedures for stress incontinence in men. • Injection Therapy – Another minimally invasive treatment option for stress incontinence involves injection of a bulking agent, most often collagen, under the lining tissues of the urethra at the bladder neck. This acts to increase outlet resistance and prevent leakage. This is a minimally invasive outpatient procedure with no incisions. Most patients are back to regular activity within a day or two. Success rates in women approach 80-85%, but the body tends to reabsorb some of the injected material, and the procedure needs to be repeated in approximately 70% of patients. • Artificial Urinary Sphincter – Prosthetic devices designed to treat incontinence have been used for more than 30 years. They are primarily used to treat men with stress incontinence after prior surgery for prostate enlargement or prostate cancer. The artificial urinary sphincter (AUS) works by placing a cuff around the urethra at the bladder neck. This is attached to a pressurized fluid reservoir placed under the abdominal muscles and a pump mechanism in the scrotum. The cuff closes to prevent leakage of urine with physical activities. To urinate, the man squeezes the pump, which opens the cuff and urine flows out of the urethra. The cuff closes automatically after about 90 seconds. The device generally works quite well, but patients have to manipulate it each time they urinate and it must be locked open if a catheter needs to be placed. Infection is a potential risk, and rates are higher in men with diabetes or a history of prior pelvic radiation therapy. This can necessitate device removal. • Bladder Augmentation – In patients with a spinal cord injury or spina bifida, urinary incontinence may occur because the bladder is small and working to store urine at high pressure. In these cases, if more conservative options using medications and other techniques have not been successful, bladder augmentation can be performed. In this procedure, a piece of small intestine is used to patch onto the bladder to make it larger and decrease storage pressures. This can reduce incontinence symptoms and also protect the kidneys from damage. • Neuromodulation – Nerve stimulators have been used to treat some forms of urinary incontinence and retention for more than ten years. These devices are surgically implanted, usually in the lower part of the back, and provide mild electrical stimulation to the nerves that control the bladder. Stimulation helps relieve symptoms of urinary urgency and urge incontinence. In some patients with urinary retention, the device can help to more completely empty the bladder, and may reduce or eliminate the need to use intermittent catheterization. The patient is able to adjust the intensity of stimulation using a hand-held remote control. • Urinary Diversion – In cases where no other treatments have been successful, urinary diversion may be an option. This is a major surgical procedure, often involving removal of the bladder with creation of either a reservoir the patient catheterizes several times daily, or a conduit with a stoma which drains urine directly into a collection bag worn on the side of the abdomen. Although usually reserved for the most challenging cases, this option can give patients a significant degree of control over elimination although the procedures are associated with significant changes in lifestyle and body image. CONCLUSIONS Urinary incontinence can be a significant healthcare problem for people of all ages. It can lead to diminished quality of life and may limit social interactions and the ability to participate in leisure activities. People need to understand they don’t have to suffer in silence, and help is available. A wide variety of both surgical and non-surgical treatments can often improve or eliminate symptoms. The choice of treatments depends on individual factors including the type of urinary incontinence and the patient’s goals of therapy. • 48 August 2009 • EP MAGAZINE/www.eparent.com http://www.eparent.com Table of Contents for the Digital Edition of Exceptional Parent - August 2009 Exceptional Parent - August 2009 Contents Ancora Imparo What's Happening Further Reading New Products 2009 Disability Awareness Night Schedule 2009 Models of Excellence in the Healthcare Profession Preterm Birth: How It Affected My Family Treatment of Neurosensory Disorders Improves Psychological Well-Being in Children Federal Program Encourages Health Service Innovations on Developmental Disabilities Close Encounters of the Medical Kind Sitting on top of the World: One Physician's Journey to Success Raising a Noonan Syndrome Child When We Found Out Our Daughter Had CMT August is Spinal Muscular Atrophy Awareness Month! Newborn Screening Saves Babies, One Foot at a Time Another Day in the Life of the National Children's Study Evidence Based Humanity Must Be Part of the Equation Incontinence Education Series Part 7 Emergency Preparedness Series Part 4 On the Road to Recovery - Self-Deiscovery: The Crown Jewel of Psychotherapy Asperger Syndrome and the Difficulties of Diagnosing and Treating Related Conditions EP Bookstore Special Needs Alliance Specialcare AADMD - American Academy of Developmental Medicine and Dentistry Organizational Spotlight Living with a Disability Exceptional Parent - August 2009 Exceptional Parent - August 2009 - Exceptional Parent - August 2009 (Page Cover1) Exceptional Parent - August 2009 - Exceptional Parent - August 2009 (Page Cover2) Exceptional Parent - August 2009 - Exceptional Parent - August 2009 (Page 1) Exceptional Parent - August 2009 - Contents (Page 2) Exceptional Parent - August 2009 - Contents (Page 3) Exceptional Parent - August 2009 - Contents (Page 4) Exceptional Parent - August 2009 - Contents (Page 5) Exceptional Parent - August 2009 - Ancora Imparo (Page 6) Exceptional Parent - August 2009 - Ancora Imparo (Page 7) Exceptional Parent - August 2009 - Ancora Imparo (Page 8) Exceptional Parent - August 2009 - Ancora Imparo (Page 9) Exceptional Parent - August 2009 - What's Happening (Page 10) Exceptional Parent - August 2009 - What's Happening (Page 11) Exceptional Parent - August 2009 - Further Reading (Page 12) Exceptional Parent - August 2009 - Further Reading (Page 13) Exceptional Parent - August 2009 - New Products (Page 14) Exceptional Parent - August 2009 - New Products (Page 15) Exceptional Parent - August 2009 - New Products (Page 16) Exceptional Parent - August 2009 - 2009 Disability Awareness Night Schedule (Page 17) Exceptional Parent - August 2009 - 2009 Models of Excellence in the Healthcare Profession (Page 18) Exceptional Parent - August 2009 - 2009 Models of Excellence in the Healthcare Profession (Page 19) Exceptional Parent - August 2009 - Preterm Birth: How It Affected My Family (Page 20) Exceptional Parent - August 2009 - Preterm Birth: How It Affected My Family (Page 21) Exceptional Parent - August 2009 - Treatment of Neurosensory Disorders Improves Psychological Well-Being in Children (Page 22) Exceptional Parent - August 2009 - Treatment of Neurosensory Disorders Improves Psychological Well-Being in Children (Page 23) Exceptional Parent - August 2009 - Treatment of Neurosensory Disorders Improves Psychological Well-Being in Children (Page 24) Exceptional Parent - August 2009 - Treatment of Neurosensory Disorders Improves Psychological Well-Being in Children (Page 25) Exceptional Parent - August 2009 - Federal Program Encourages Health Service Innovations on Developmental Disabilities (Page 26) Exceptional Parent - August 2009 - Federal Program Encourages Health Service Innovations on Developmental Disabilities (Page 27) Exceptional Parent - August 2009 - Close Encounters of the Medical Kind (Page 28) Exceptional Parent - August 2009 - Close Encounters of the Medical Kind (Page 29) Exceptional Parent - August 2009 - Close Encounters of the Medical Kind (Page 30) Exceptional Parent - August 2009 - Close Encounters of the Medical Kind (Page 31) Exceptional Parent - August 2009 - Sitting on top of the World: One Physician's Journey to Success (Page 32) Exceptional Parent - August 2009 - Sitting on top of the World: One Physician's Journey to Success (Page 33) Exceptional Parent - August 2009 - Raising a Noonan Syndrome Child (Page 34) Exceptional Parent - August 2009 - Raising a Noonan Syndrome Child (Page 35) Exceptional Parent - August 2009 - When We Found Out Our Daughter Had CMT (Page 36) Exceptional Parent - August 2009 - When We Found Out Our Daughter Had CMT (Page 37) Exceptional Parent - August 2009 - August is Spinal Muscular Atrophy Awareness Month! (Page 38) Exceptional Parent - August 2009 - Newborn Screening Saves Babies, One Foot at a Time (Page 39) Exceptional Parent - August 2009 - Another Day in the Life of the National Children's Study (Page 40) Exceptional Parent - August 2009 - Another Day in the Life of the National Children's Study (Page 41) Exceptional Parent - August 2009 - Another Day in the Life of the National Children's Study (Page 42) Exceptional Parent - August 2009 - Another Day in the Life of the National Children's Study (Page 43) Exceptional Parent - August 2009 - Evidence Based Humanity Must Be Part of the Equation (Page 44) Exceptional Parent - August 2009 - Evidence Based Humanity Must Be Part of the Equation (Page 45) Exceptional Parent - August 2009 - Incontinence Education Series Part 7 (Page 46) Exceptional Parent - August 2009 - Incontinence Education Series Part 7 (Page 47) Exceptional Parent - August 2009 - Incontinence Education Series Part 7 (Page 48) Exceptional Parent - August 2009 - Emergency Preparedness Series Part 4 (Page 49) Exceptional Parent - August 2009 - Emergency Preparedness Series Part 4 (Page 50) Exceptional Parent - August 2009 - Emergency Preparedness Series Part 4 (Page 51) Exceptional Parent - August 2009 - On the Road to Recovery - Self-Deiscovery: The Crown Jewel of Psychotherapy (Page 52) Exceptional Parent - August 2009 - On the Road to Recovery - Self-Deiscovery: The Crown Jewel of Psychotherapy (Page 53) Exceptional Parent - August 2009 - On the Road to Recovery - Self-Deiscovery: The Crown Jewel of Psychotherapy (Page 54) Exceptional Parent - August 2009 - On the Road to Recovery - Self-Deiscovery: The Crown Jewel of Psychotherapy (Page 55) Exceptional Parent - August 2009 - Asperger Syndrome and the Difficulties of Diagnosing and Treating Related Conditions (Page 56) Exceptional Parent - August 2009 - Asperger Syndrome and the Difficulties of Diagnosing and Treating Related Conditions (Page 57) Exceptional Parent - August 2009 - Asperger Syndrome and the Difficulties of Diagnosing and Treating Related Conditions (Page 58) Exceptional Parent - August 2009 - Asperger Syndrome and the Difficulties of Diagnosing and Treating Related Conditions (Page 59) Exceptional Parent - August 2009 - EP Bookstore (Page 60) Exceptional Parent - August 2009 - EP Bookstore (Page 61) Exceptional Parent - August 2009 - Special Needs Alliance (Page 62) Exceptional Parent - August 2009 - Special Needs Alliance (Page 63) Exceptional Parent - August 2009 - Specialcare (Page 64) Exceptional Parent - August 2009 - Specialcare (Page 65) Exceptional Parent - August 2009 - Specialcare (Page 66) Exceptional Parent - August 2009 - Specialcare (Page 67) Exceptional Parent - August 2009 - AADMD - American Academy of Developmental Medicine and Dentistry (Page 68) Exceptional Parent - August 2009 - AADMD - American Academy of Developmental Medicine and Dentistry (Page 69) Exceptional Parent - August 2009 - AADMD - American Academy of Developmental Medicine and Dentistry (Page 70) Exceptional Parent - August 2009 - Organizational Spotlight (Page 71) Exceptional Parent - August 2009 - Organizational Spotlight (Page 72) Exceptional Parent - August 2009 - Organizational Spotlight (Page 73) Exceptional Parent - August 2009 - Living with a Disability (Page 74) Exceptional Parent - August 2009 - Living with a Disability (Page Cover3) Exceptional Parent - August 2009 - Living with a Disability (Page Cover4) http://www.eparentdigital.com/nxtbooks/exceptionalparent/201009 http://www.eparentdigital.com/nxtbooks/exceptionalparent/201008 http://www.eparentdigital.com/nxtbooks/exceptionalparent/201007 http://www.eparentdigital.com/nxtbooks/exceptionalparent/201006 http://www.eparentdigital.com/nxtbooks/exceptionalparent/201005 http://www.eparentdigital.com/nxtbooks/exceptionalparent/201004 http://www.eparentdigital.com/nxtbooks/exceptionalparent/201003 http://www.eparentdigital.com/nxtbooks/exceptionalparent/201002 http://www.eparentdigital.com/nxtbooks/exceptionalparent/2010rg http://www.eparentdigital.com/nxtbooks/exceptionalparent/200912 http://www.eparentdigital.com/nxtbooks/exceptionalparent/200911 http://www.eparentdigital.com/nxtbooks/exceptionalparent/200910 http://www.eparentdigital.com/nxtbooks/exceptionalparent/200909 http://www.eparentdigital.com/nxtbooks/exceptionalparent/200908 http://www.eparentdigital.com/nxtbooks/exceptionalparent/200907 http://www.eparentdigital.com/nxtbooks/exceptionalparent/200906 http://www.nxtbookMEDIA.com
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