Nurse Continence Advisor (go to Professional List)

A Nurse Continence Advisor (NCA) is a nurse who has been specially educated to help people with bladder control problems. The focus of the Nurse Continence Advisor is to help you learn what you can do to regain bladder control.

The first step when seeing a NCA is a thorough assessment. Be prepared to spend at least one hour. The nurse will ask you questions about your problem. The visit includes an examination and some simple testing. You will be asked to urinate then you may have an ultrasound to see how well you empty your bladder.

Once the assessment is completed, you and the NCA will form a plan to follow. The plan will be based on your concerns. Education is a major part. You will learn how your bladder works and what can cause leakage problems. You might be asked to make some lifestyle changes. You will be shown how to do pelvic muscle exercises correctly. Some people have difficulty exercising these muscles. For these people, different techniques may be used. These would be explained at the time of your visit. While working with the nurse to treat your incontinence, you may require absorbent products to keep dry. The NCA has expert knowledge in products and can often provide you with samples to try.

Follow up visits are important. The NCA is your partner in working towards bladder control.

To find a Nurse Continence Advisor in your area, contact the Canadian Continence Foundation or the Canadian Nurse Continence Advisor Association at www.cnca.ca. In Canada, a nurse continence advisor is trained through a six to nine-month course, offered as a distance education program through McMaster University. The course work includes an educational component assessed by an examination and a major project. The clinical piece requires the nurse to work with an experienced NCA to gain expertise.

Physiotherapist (go to Professional List)

The physiotherapist is a health care provider who can provide you with valuable advice and an exercise program to help you control your bladder. After a detailed questionnaire and a physical evaluation of your pelvic floor muscles (the muscles that lie underneath the bladder), the
physiotherapist will sit down with you to explain how your bladder works, and what you can do to prevent urine leakage. Advice may include dietary changes, changes in the timing of your visits to the bathroom, and hints to help you decrease the urgency to empty your bladder. A pelvic floor
exercise program will be set up for you, but first the physiotherapist will make sure that you understand how to do the exercises correctly. She may suggest the use of different techniques to help you with your exercise program. These techniques may include:

• Manual techniques: Pressure, massage and stretch techniques are performed by the hysiotherapist on the surface of the muscles in the pelvis, in order to help you contract your muscles more fficiently.
  
• Biofeedback: A probe is placed in the vagina ( for women ) or in the anus (for men). This probe is able to read the activity of your pelvic floor muscles for display on a screen, and will help you with your training by allowing you to see how well you are performing your exercises.
  
• Electrical stimulation: With a probe placed in the vagina or in the anus, an electric current is applied to the muscles to help you feel them and to give you the sensation of a pelvic floor contraction. This will help you to perform the exercises more easily.

You may see the physiotherapist once or twice for advice and a home program, or you may follow a training program with her for several weeks, depending upon your particular situation.

Your doctor will be able to tell you whether physiotherapy is a good treatment option for your particular problem.

Pelvic floor physiotherapists are available for consultation both in the public and in the private sectors.

Urogynaecologist (go to Professional List)

A urogynaecologist is a medical doctor who has received special training to understand what causes problems with women’s bladders, especially leaking from the bladder (urinary incontinence). If your family doctor sends you to see a urogynaecologist the following things will usually happen:

• The urogynaecologist will ask you questions about your problem and also about your general health (your medical history)
  
• She or He will perform a physical examination including a pelvic examination to look at the uterus, ovaries and bladder.

After the examination the urogynaecologist will discuss your problem and provide an explanation about the cause for it and what treatments are recommended.

The urogynaecologist may suggest other tests such as:

• Cystoscopy - looking inside your bladder with a light.
  
• Urodynamics – placing small catheters in the bladder to test how it holds your urine and why it leaks.
  
• Urinanalysis and/or Urine Culture – sending a sample of your urine to the lab to test for infection.

A urogynaecologist can offer you a wide variety of treatments for your bladder problem. For urinary incontinence you may be offered:

• Advice about changing the types and quantities of fluids you drink- reducing caffeine can help your bladder.
  
• Instructions for exercises (Kegel’s exercises) to strengthen the muscles that hold your urine in your bladder.
  
• A supportive pessary (a device that fits in the vagina to support the bladder and stop leaking with coughing and sneezing).
  
• Surgery to stop the leaking

Urologist (go to Professional List)

A urologist is a surgeon who specializes in conditions involving the urinary tract. He or she is specifically trained to understand all medical conditions affecting the bladder, including ncontinence (urinary leakage).

If your family doctor sends you to see a urologist the following things will usually happen:

• He or she will ask you questions about your problem and also about your general health (your medical history)
  
• A physical examination is usually performed, including a pelvic examination

After the examination the urologist will discuss your problem and provide an explanation about the cause for it and what treatments are available. Treatment recommendations will then be made, based on your specific situation.

he urologist may suggest other tests such as:

• Cystoscopy - looking inside your bladder with a light.
  
• Urodynamics – placing small catheters in the bladder to test how it holds your urine and why it leaks.
  
• Urinanalysis and/or Urine Culture – sending a sample of your urine to the lab to test for infection.

A urologist can offer you a wide variety of treatments for your bladder problem. For urinary incontinence you may be offered:

• Education and advice about changing the types and quantities of fluids you drink- eg. reducing caffeine can help your bladder.
• Instructions for exercises (Kegel’s exercises) to strengthen the muscles that hold your urine in your bladder.
  
• Surgery to stop the leaking. There are many successfull surgical therapies for different types of incontinence, and your urologist will be trained to offer you the best treatment for your specific situation.