Pelvic Health Support

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    • An increase in the size of the prostate gland (a walnut-sized body part made of glandular and muscular tissue)
    • The prostate surrounds part of the urethra, which is the tube that carries urine and sperm outside of the body
    • Almost all men will develop some enlargement of the prostate as they grow older
      • By age 60, 50% of men will have some signs of BPH
      • By age 85, 90% of men will have signs of the condition   
    • Approximately 50% of men will develop symptoms that need to be treated                                            
Potential Causes
    • Aging: Increased prostate cell growth from lower levels of testosterone and higher levels of estrogen and dihydrotestosterone (DHT)
    • Urinary frequency
    • Urinary urgency
    • Slowness/dribbling of your urinary stream
    • Hesitancy/difficulty starting to urinate
    • Nocturia (Nighttime voiding)
    • Pain after ejaculation/while urinating
    • Urine that has a different odour/colour than usual
    • The enlargement of the prostate can lead to blockage of the urethra, which can lead to:
      • Bladder stones
      • Bladder infection
      • Blood in your urine
      • Kidney damage from back pressure caused by retaining large amounts of extra urine in the bladder
    • Medical history to address
      • Symptoms
      • Current health issues
      • Over-the-counter and prescription drugs being taken
      • Diet and liquid consumption
    • Physical exam
    • Digital rectal exam: To feel the prostate and estimate its size
    • Urine flow study: May be conducted to measure how slow the urinary stream is compared with normal urine flow
    • Ultrasound post-urination: To determine if there is any urine left in the bladder
    • Cystoscopy: Bladder is looked at through a cystoscope
    • Oral Medications
      • Drugs that relax the muscle in the prostate (to reduce the tension on the urethra)
        • Include doxazosin, tamsulosin, alfuzosin and silodosin
      • Drugs that decrease the production of the hormone dihydrotestosterone (DHT), which affects the growth of the prostate gland
        • Include finasteride and dutasteride 
      • To help treat symptoms and improve the flow of urine
          • Dutasteride and tamsulosin combined
    • Surgery
      • Transurethral resection of the prostate (TURP): The tissue that blocks the urethra is removed with a special instrument
      • Transurethral incision of the prostate (TUIP): Two small cuts are made in the bladder neck (where the urethra and bladder join) and in the prostate to widen the urethra to improve urine flow
      • Transurethral electrovaporization: Electrical energy is applied through an electrode to rapidly heat prostate tissue, turning the tissue cells into steam. The enlarged tissue area can then be vaporized to relieve urinary blockage
      • The GreenLight laser: Prostate tissue is removed with a laser
    • Minimally Invasive Treatments
        • Prostatic Urethral Lift: Separates the enlarged prostate lobes to make the urethra wider so that it is easier to urinate
        • Water Vapour Therapy: Delivers very small amounts of steam to the enlarged prostate to damage the cells causing obstruction, thus reducing the overall size of the prostate
    • Inflammation of the prostate gland
    • When symptoms start gradually and linger for more than 2 wks
    • Affects adult men of all ages and from all backgrounds
    • About 5% of men experience symptoms of chronic prostatitis at some point in their lives
    • Types:
    • Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS): Inflammation of the prostate and an irritation of the nerves which supply this area
      • No bacteria are found in a urine sample
    • Chronic Bacterial Prostatitis: Uncommon
      • Tends to come and go over a long period of time
    • Acute Bacterial Prostatitis: Uncommon
      • Bacteria is present in the urine
    • Asymptomatic Inflammatory Prostatitis: No evidence of prostate infection or inflammation is found
      • Could potentially be a result of abnormal buildup of pressure in the urinary tract
Potential Causes
    • Most often, the nerves and muscles in the pelvis cause pain because of a local inflammation that effects the nerves in the area
    • Less commonly, bacterial infection (if it’s a bacterial type of prostatitis) when infected urine flows backwards from the urethra
    • Nonbacterial prostatitis may be linked to stress, nerve inflammation/irritation, injuries or prior urinary tract infections
    • Can be a reaction to an infection/past injury
    • Frequent/urgent need to urinate
    • Burning during/after urination
    • Difficulty starting the urine stream
    • Dribbling after urination is complete
    • A sensation that the bladder cannot be fully emptied
    • Pain felt above the penis, in/below the scrotum or in the back/rectum
    • Pain experienced during or after orgasm
    • Chills & fever (Bacterial prostatitis only)
  • Medical history to address
    • Symptoms
    • Current health issues
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption
    • Sexual history
  • Physical exam: Your doctor will examine your prostate gland by inserting a gloved and lubricated finger into your rectum
    • In chronic prostatitis, the gland may be swollen or firm or it may feel normal
  • Urine Sample: Prior to and post exam to check for white blood cells and bacteria
    • Oral Medications
      • Nonsteroidal anti-inflammatories (NSAIDs) and muscle relaxants for pain and muscle spasms
      • Alpha-blocker medications to relax the muscles that control the bladder and relieve symptoms of urgency, hesitancy or dribbling
      • Antibiotics (for chronic and acute bacterial prostatitis)
    • Heat application: Baths, heating pads and hot water bottles
    • Acupuncture: The insertion of very fine needles to alleviate pain in strategic points
    • Biofeedback: Designed to ease pressure and reduce pelvic floor tension
    • Diet Modification: Cutting out caffeine, alcohol, carbonated beverages and spicy/acidic foods may reduce irritation of the bladder and prostate
    • When the bladder does not empty properly
Potential Causes
    • Obstruction in the urinary tract
    • Enlarged prostate gland can press on the urethra (in men)
    • Cystocele: A bladder that sags (in women)
    • Rectocele: Rectum that sags into the back wall of the vagina (in women)
    • Drugs including antihistamines, antispasmodics, anticholinergics and tricyclic antidepressants that can change the way the bladder muscle works
    • Urethral stricture
    • Urinary stones
    • Catheter use
    • Nerve problems that interfere with signals from the brain to the bladder
    • Nerves can be damaged from vaginal childbirth, spinal cord injuries/infections, diabetes, stroke, multiple sclerosis, pelvic injury/trauma and benign prostatic hyperplasia
    • If the bladder tries to release but cannot due to weak pelvic floor muscles or the sphincter not relaxing at the right time
    • A struggle to start the flow of urine
    • Weak flow
    • Feeling the need to go, but cannot start
    • Feeling the need to urinate right after you’ve gone
    • Medical history: To address past and current health issues and over-the-counter and prescription drugs being taken
    • Physical exam: Of the lower abdomen (for men and women) and prostate check (for men)
    • Urinalysis: To test for infection/blood/abnormalities
    • Bladder ultrasound: To show how much urine is still in the bladder post-urination
    • Cystoscopy: To look at the lining of your urethra and bladder to check for urethral stricture, a blockage caused by a stone, an enlarged prostate or a tumour
    • CT scan: Can help find stones or anything else blocking the flow of urine
    • Catheter tests: Can determine urine flow rate and how well the bladder empties
    • Prostate-specific Antigen (PSA) blood test: To screen for prostate cancer
    • Electromyography (EMG): Uses sensors to measure electrical activity of muscles and nerves in and near the bladder and urethral sphincter
    • Enlarged Prostate
      • Oral Medications: Alpha-blockers and 5-alpha reductase inhibitors to help shrink the prostate
      • Laser therapy: To break up the blockage
      • Surgery: Transurethral resection of the prostate to remove a section of the prostate
    • Cystocele/Rectocele
      • Pelvic Physiotherapy: To strengthen the pelvic floor muscles
      • Vaginal Pessary: Insertion of vaginal pessary (ring) to support the bladder
      • Estrogen Therapy: For post-menopausal women
      • Surgery: To lift the sagging bladder/rectum
    • Urethral Stricture
      • Using catheters and balloons to open the urethra
      • Stent: Can prop open a closed urethra (in men)
      • Surgery: Using a knife/laser to make a cut to open the stricture
    • Nerve-related
      • Self-catheterization
Fowler's Syndrome
    • Caused by spasms of the external urethral sphincter (a band of muscle that opens and closes at the exit of the bladder)
    • Affects young women (under the age of 30), leading to urinary retention
Potential Causes
    • Unknown 
    • Often seen in women who have had a surgical procedure, childbirth, opiate exposure or an infection/illness
    • Inability to urinate
    • Inability to feel that the bladder is full
    • Abnormality of the urethra 
    • Dysuria (painful/difficult urination)
    • Stomach pain
    • Polycystic ovaries
    • EMG abnormality
    • Rule out more common causes of urinary retention
    • Determine how much urine the bladder can hold 
    • Concentric Needle Electromyography (EMG): Will often show a characteristic abnormality
    • Sacral Neuromodulation (SNM) Therapy: A device is implanted in the body to help stimulate the nerves to the bladder
      • A chronic bladder condition with lower urinary tract symptoms lasting over 6 wks with no diagnosis of infection or other clear cause
      • Two types
        • Hunner’s Ulcers
          • Distinctive areas of inflammation on the bladder wall that characterize the classic form of IC
          • 5-10% of IC patients
        • Non-Ulcerative
          • Pinpoint hemorrhages, also known as glomerulations, in the bladder wall
          • Also referred to as Bladder Pain Syndrome
          • 90% of IC patients
      • Difficult to estimate the number of people affected as a result of there being no standard diagnostic protocol
      • Typically 2-3x more common in women than in men
      • Risk increases with age
Potential Causes
    • What causes IC/BPS is not exactly known, but there are many theories including:
      • A defect in the bladder tissue, which may allow irritating substances in the urine to penetrate the bladder
      • A specific type of inflammatory cell, called a mast cell. This cell releases histamine and other chemicals that lead to IC symptoms
      • An agent in the urine that causes damage to the bladder
      • Changes in the nerves that carry bladder sensations so pain is caused by events that are not normally painful (ie: bladder filling)
      • The immune system attacks the bladder
    • Vary for each patient and range from mild to severe
    • Suprapubic/pelvic pain that may worsen as the bladder fills, be constant or may come and go
      • Can be felt in other areas including the urethra, lower abdomen, lower back,
        pelvic/perineal area, vulva/vagina (in women) and scrotum/testicles/penis (in men)
      • Pressure/discomfort when the bladder is filling
      • Urinary frequency often of small amounts, upwards of 60x a day
        • Average number of times a person urinates per day: 7
      • Persistent urinary urgency that can be triggered by
        • Certain foods/beverages
        • Physical/mental stress
        • Menstrual cycle
        • Sexual intercourse
    • Medical history to
      • Address symptoms
      • Past and current health problems
      • Over-the-counter and prescription drugs being taken
      • Diet and liquid consumption
    • Tests
      • Baseline Pain Evaluation: Series of questionnaires to determine your baseline pain value with the goal of finding pain location(s), intensity and characteristics and identifying factors that make pain/discomfort better or worse
      • Voiding Diary: To evaluate your voiding patterns 
      • Urodynamic Evaluation: The bladder is filled with water through a catheter to measure bladder pressures as it fills and empties *IC patients have a low capacity and potential pain with filling
      • Cystoscopy: Bladder is looked at through a cystoscope and often the bladder will be filled with water to see how much it can hold
        • If Hunner’s ulcers are seen (distinctive areas of inflammation on the bladder wall), the diagnosis is fairly certain

*All IC patients respond differently so trial and error needs to be carried out in order to determine what will work best for you

    • Diet: Certain foods can worsen symptoms
      • Bladder irritants for most: Alcohol, caffeine, artificial sweeteners, carbonated beverages, chocolate, citrus fruits, tomatoes and spicy food (See Diet section for a more extensive list)
      • Determining which foods irritate your bladder can be discovered through an elimination diet
    • Physical Activity: Walking and gentle stretching
    • Stress Reduction: Learning stress reduction methods including mindfulness meditation and restorative yoga can be helpful, as stress is a major flare trigger. (See the Lifestyle section)
    • Pelvic Physiotherapy: To reduce tenderness/pain/spasms in the pelvic floor area through exercise and massage
      • The Canadian Urological Association (CUA) recommends that everyone diagnosed with IC has a pelvic floor exam, looking for trigger points
      • Studies show that 79% of people with IC/BPS have trigger points in the pelvic floor
      • Up to 83% of patients who see a pelvic floor physiotherapist have their symptoms improved/resolved
    • Bladder Retraining: Helping you begin to hold more urine for longer periods of time by gradually increasing the time between each visit to the bathroom
      • Track the number of times and how often you have the urge to urinate 
      • Use the diary to gradually increase the length of time between bathroom breaks
    • Medications (Oral & Intravesical)
      • Pentosan polysulfate sodium (Elmiron): Used for treating pain
        • It could take up to 6 months before any improvement is noticed
        • Ophthalmic screening is advised for any patient who has taken Elmiron with any vision complaints for evidence of retinal maculopathy
      • Heartburn medications: To reduce the amount of acid made by the body
      • Muscle relaxants: Can help relieve the symptoms by keeping the bladder from squeezing at the wrong time
      • Antihistamines: Decrease the amount of histamine in the bladder that leads to pain and other symptoms
      • Tricyclic antidepressants: Amitriptyline/nortriptyline have been shown to decrease bladder spasms and slow the nerves that carry pain messaging
      • Bladder Instillations: The bladder is filled with liquid medication including Dimethyl Sulfoxide (DMSO) and Heparin, through a catheter
        • DMSO may block swelling, decrease pain sensation and remove free radical toxins that can cause tissue damage
        • Combined with Heparin/steroids to decrease inflammation
      • Bladder Stretching/Hydrodistension: The bladder is filled with sterile water in order to distend it and increase the amount of urine it can hold
      • Neuromodulation Therapy
        • Delivers harmless electrical impulses to nerves to change how they work
        • More effective for urgency/frequency reduction, but can sometimes help with the bladder/suprapubic pain
      • Sacral Neuromodulation (SNS)
        • Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
        • Electrical wire is implanted under the skin in the lower back
        • It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
        • If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted
      • Cauterization/Steroid Injections: May provide long-term relief for those with Hunner’s ulcers for up to a year or more
      • Injections: To relieve pain, botulism is injected through a catheter to paralyze the bladder muscle
        • These often need to be repeated every 6-9 months
      • Cyclosporine: Immunosuppressant therapy reserved for severe cases only
      • Surgery: Bladder/parts of the bladder are removed
        • Reserved for patients with severely limited bladder capacity or severe symptoms that have not responded to other treatments
    • Chronic testicular pain lasting more than 3 months
    • Can come on suddenly/gradually
Potential Causes
    • Spontaneous
    • As a result of an infection (UTI/STI)
    • Trauma
    • Inflammation
    • Surgery
    • Pain originating from the scrotum
    • Physical exam
    • STI screening (if applicable)
    • Urine sample
    • Ultrasound to rule out other pathology
    • Heat application: Warm baths, heating pads, hot water bottles
    • Oral medications: Anti-inflammatories
    • Wearing tight-fitting underwear
    • Avoiding heavy lifting
    • Pelvic physiotherapy: If pain is due to muscle spasming
    • Temporary spermatic cord block: Local anesthetic is injected into the spermatic cord (the structure carrying the vas, nerves, blood vessels and lymphatics to the testicle)
    • Surgery: Microsurgical Cord Denervation if the temporary cord block is successful
      • The cord is exposed and the nerve containing structures are cut while the blood and lymphatic supply are maintained
      • Provides long-term pain relief in over 70% of patients who have
        • Chronic pain lasting more than 3 months
        • Failed other medical interventions and therapies
        • Received temporary relief with a cord block
    • Name for a group of urinary symptoms
    • Sudden, uncontrolled need or urge to urinate
    • The need to pass urine many times during the day and night
    • Can result if the nerve signals between your bladder and brain are not working properly so that your bladder muscle contracts before it’s full
    • You are more susceptible to OAB if
      • You live a sedentary lifestyle and are overweight
      • You do not manage chronic conditions such as diabetes
      • You live with a neurologic condition ie: Multiple Sclerosis, have suffered a stroke
      • You have a hypotonic (weak) pelvic floor
Potential Causes
    • Neurologic disorders/damage to the signals between your brain and bladder
    • Hormone changes
    • Pelvic muscle weakness/spasms
    • A urinary tract infection (UTI)
    • Side effects from a medication
    • Urgency: A sudden, strong urge to urinate that cannot be ignored
    • Urge Incontinence: The loss of bladder control
    • Frequency: Having to urinate over 8 times/day
    • Nocturia: Waking more than once a night to urinate
    • Medical History to address
      • Past and current health issues
      • Over-the-counter and prescription drugs being taken
      • Diet and liquid consumption
    • Bladder Diary 
        • Over a few weeks, record
          • When and how much fluid you drink
          • When and how much you urinate
          • How often you have that “gotta go” urgency feeling
          • When and how much urine you may leak
    • Tests
      • Urinalysis: To check for infection/blood/other abnormalities
      • Bladder scan: To show how much urine is still in the bladder after you urinate
      • Cystoscopy: To look at the bladder through a cystoscope to rule out other conditions
    • Diet: Limit foods and drinks that irritate the bladder including caffeine, carbonated beverages, alcohol, spicy and acidic foods
    • Bladder diary: To help you find patterns ie: bothersome foods, liquid consumption
    • Double voiding: After you think you’ve finished emptying your bladder, try again
    • Delayed voiding: Try to hold off when you have to urinate if the urgency is not severe
    • Timed urination: Urinate only at set times during the day
      • The goal is to prevent that urgent feeling and to regain control
    • Bladder muscle relaxation exercises
      • Kegels: To strengthen the pelvic floor
      • Quick Flicks: Squeeze and relax your pelvic floor muscles over and over again
      • Biofeedback: Computer graphs and sounds to monitor muscle movement help teach you how your pelvic muscles move and how strong they are
    • Prescription drugs (Oral & Intravesical)
      • Antimuscarinics & Beta-3 Adrenoceptor Agonists: Can relax the bladder and increase the amount of urine your bladder can hold and empty
      • Botox: Relaxes the muscle of the bladder wall to reduce urgency and urge incontinence
        • Effects can last up to 6 months
    • Neuromodulation therapy: Electrical pulses are sent to nerves that share the same path for the bladder
      • Help the brain and the nerves to the bladder communicate so the bladder can function properly
    • Percutaneous Tibial Nerve Stimulation (PTNS): Small electrode is placed near your ankle and pulses are sent to the tibial nerve to help control the signals that aren’t working right
      • 12 treatments are usually required
    • Sacral Neuromodulation (SNS): Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
      • Electrical wire is implanted under the skin in the lower back
      • It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
      • If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted
    • Bladder Reconstruction/Urinary Diversion Surgery: Used only in rare and severe cases
    • Augmentation Cystoplasty: Enlarges the bladder
    • Urinary Diversion: Reroutes the flow of urine
    • Urinary Tract Infection (UTI): Bacterial infection of the urinary system causing an inflammatory response
      • Can affect any part of your urinary system: Bladder, kidneys, urethra and/or ureters
      • Usual Uropathogens: Escherichia coli, Staphylococcus saprophyticus, Klebsiella pneumoniae and Proteus mirabilis
      • A threshold of 3 UTIs in 12 months is used to signify recurrent UTI
    • The Pathogenesis of Recurrent UTI: Involves bacterial reinfection/bacterial persistence, with the former being much more common
      • Reinfection
        • Recurrence with the same organism in more than 2 weeks after treatment, a different organism or a sterile intervening culture
      • Bacterial Persistence
          • The same bacteria may be cultured in the urine 2 weeks after initiating sensitivity-adjusted therapy
Potential Causes
  • More prevalent in women
    • Urethra is closer to the rectum
    • Urethra is shorter
    • Diaphragm use
    • The use of products that can change the bacterial makeup of the vagina ie: spermicides, vaginal douches
    • Menopause due to hormonal changes resulting in modified vaginal bacteria
    • Invasion of E.Coli bacteria into the urinary tract as a result of:
      • Improper wiping
      • Toilet water backsplash
      • Sexual intercourse
  • In men
    • Enlarged prostate: The bladder does not empty completely, enabling bacteria to grow more easily
  • Neurogenic bladder: More prone to recurrent UTIs, as a result of issues with bladder muscle function (urinary retention)
    • Frequent urination
    • A burning sensation while urinating
    • Bloody/dark urine
    • Pain in your bladder/kidney regions
    • Urine culture: To determine which bacteria are present
    • Cystoscopy: To look inside the urethra and bladder to see if there are any abnormalities/issues that could cause the UTI to keep coming back
  • Antibiotics
    • For a week followed by long term, low-dose antibiotics after the initial symptoms subside
    • Post-intercourse
    • When on antibiotics, be sure to take probiotics to replenish good bacteria in your system
  • Estrogen therapy: For menopausal women
  • Water: Drink lots to dilute your urine and help flush out bacteria
  • Heat application: Use a heating pad/hot water bottle on your bladder
Urethral Stricture Disease
    • When a scar from swelling, injury or infection blocks/slows the flow of urine in the urethra
    • Can be painful for some
    • Men are more susceptible, as a result of having longer urethras than women
    • 2 Types are Posterior and Anterior
    • Posterior: Happens in the first 1-2” of the urethra
      • Due to an injury from a pelvic fractur
      • Urethra is disrupted and completely cut/separated
      • Urine cannot pass
    • Anterior: Happens in the first 9-10” of the urethra
      • Due to trauma from a straddle injury, direct trauma to the penis or from urinary catheterization
    • Trauma to the urethra from a fall
    • Infection
    • Damage from surgical tools
    • Conditions that cause swelling
    • Urinary catheterization
    • Prostate surgery
    • Kidney stone removal
    • Decreased urine stream
    • Incomplete emptying of the bladder
    • Urine stream spraying
    • Straining or pain when urinating
    • Urinary frequency
    • Urinary urgency
    • UTIs in men
    • Physical exam
    • Urethral imaging: X-rays/ultrasound
    • Urethroscopy: To see the inside of the urethra
    • Retrograde Urethrogram: Uses x-ray images to check for a structural problem/injury of the urethra as well as the length and location of the stricture along the urethra

*Dependent on the size of the blockage and how much scar tissue there is

  • Dilation: Enlarging the stricture with gradual stretching
  • Urethrotomy: Cutting the stricture with a laser/knife through a scope
  • Urethroplasty: Surgically removing the narrowed section of the urethra/enlarging it
    • The procedure might also involve reconstruction of the surrounding tissues through the use of skin/mouth grafts
    • Condition that affects the urethra (the tube that carries urine from the bladder to outside the body)
    • Inflamed/irritated urethra
    • Most common in women
Potential Causes
    • Physical problems with the urethra such as abnormal narrowing, urethral irritation or injury
    • The urethra can be irritated by:
      • Scented products (perfumes, soaps, bubble bath and sanitary napkins)
      • Spermicidal jellies
      • Certain foods and drinks containing caffeine
      • Chemotherapy and radiation
    • The urethra can be injured by:
      • Sexual activity
      • Diaphragm use
      • Tampon use
      • Bike riding
    • Increased risk of developing urethral syndrome if you:
      • Are prone to bacterial bladder/kidney infections
      • Take certain medications
      • Have sex without a condom
      • Have an STI
    • Pain with urination
    • Lower abdominal pain/pressure
    • Urinary urgency
    • Urinary frequency
    • Urinary difficulty
    • Pain during sex
    • Blood in the urine
    • Bladder not feeling empty after urinating
    • Swelling of the testicles (men)
    • Pain while ejaculating (men)
    • Blood in the semen/urine (men)
    • Discomfort in the vulvar area (women)
    • Medical history review and symptom evaluation
    • Physical exam including the genitals, abdomen and rectum
    • Urine sample: To rule out bacterial infection
    • Urethroscopy: To see the inside of the urethra
    • Pelvic ultrasound
  • Lifestyle changes: Refrain from using products, eating/drinking food and beverages or doing activities that can irritate the urethra
  • Medications
    • Anesthetics: Phenazopyridine, Lidocaine 
    • Antispasmodics: Hyoscyamine, Oxybutynin
    • Tricyclic Antidepressants: Amitriptyline, Nortriptyline
      • Act on your nerves to help relieve chronic pain
  • Alpha-blockers: Doxazosin, Prazosin
    • Improve blood flow by relaxing the muscles in your blood vessels
  • Dilation/Surgery: To widen your urethra if the syndrome is due to constriction
    • Uncontrolled leaking of urine
    • Affects 1 in 4 women and 1 in 9 men in Canada
    • Only 1 in 12 will seek treatment
    • 5 Types
    • Stress Urinary Incontinence (SUI): Most common, especially in older women
      • Happens when the pelvic floor muscles stretch
    • Overactive Bladder (OAB): Urgency incontinence and urinary frequency
    • Mixed Incontinence (SUI & OAB): Leak urine with activity (SUI) and often feel the urge to urinate (OAB)
    • Urge Incontinence: The sudden loss of bladder control secondary to a strong and overwhelming urge to go to the bathroom
      • There can be a small amount of urine loss or complete emptying of the bladder
    • Overflow Incontinence: Most common in men with prostate issues
      • The body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing leakage
      • In addition, there may be something blocking the flow or the bladder muscle may not contract as it should
Potential Causes
    • Aging
    • Pregnancy, childbirth and number of children
    • Post-menopause potentially due to the drop in estrogen in women
    • Prostate problems
    • Some medications
    • Neurological diseases
    • Increased risk for those who smoke, are obese, have high blood pressure and/or diabetes
    • SUI: Leaking when you are physically active
    • OAB: Needing to urinate more than normal
      • Urinary urgency that sometimes cannot be controlled
      • May/may not cause your bladder to leak urine
      • Nocturia (nighttime urination)
    • Mixed SUI & OAB: Leaking AND a sudden strong urge to urinate
    • Overflow Incontinence: Frequent, small urinations and constant dribbling
    • Medical history to address
      • Past and current health issues
      • Over-the-counter and prescription drugs being taken
      • Diet and liquid consumption
    • The Three Incontinence Questions Tool
      • Asks if, when and how often urine leakage is experienced
      • Can help categorize the type of urinary incontinence
    • Three-day Voiding Diary
      • Used as part of the initial assessment for urinary incontinence symptoms
      •  Record
        • When and how much fluid you drink
        • When and how much you urinate
        • How often you have that “gotta go” urgency feeling
        • When and how much urine you may leak
    • Cough Stress Test: Most reliable clinical assessment for confirming SUI
    • Urodynamic Testing: To determine how well the bladder, sphincters and urethra hold and release
    • Postvoid Residual Urine Measurement
      • You’re asked to urinate (void) into a container that measures urine output
      • The amount of leftover urine in your bladder is checked using a catheter/ultrasound
    • Indwelling Catheters: Flexible tube placed in your bladder all day and night. A balloon holds the tube in your bladder and drains urine into an external bag
    • Intermittent Catheterization: Catheter is inserted into the urethra 3-5x/day. Once the bladder is empty, you remove the catheter
    • Urethral Insert: Inserted into the distal portion of the male urethra, inhibiting the flow of urine. Can be removed before urination and reinserted after urination
    • Absorbent Products: Pads, adult diapers, protective underwear, guards and drip collection pouches for men
    • Toilet Substitutes: Commode seats, bedside commodes, urinals (plastic jug-type devices)