How is incontinence treated?
Urinary incontinence can be caused by many different factors. Your doctor will suggest a treatment plan after considering these factors and your specific symptoms.
Treatments for Urge Incontinence/Overactive Bladder:
Medications for "overactive bladder"
There are a number of medications that can reduce leakage. Some of these drugs inhibit an overactive bladder’s activities by stabilizing muscle contractions and others have the opposite effect of relaxing muscles to permit more complete bladder emptying. Hormone replacement therapies, usually involving estrogen, may help restore normal bladder function.
Medications can work very well to return normal function to the bladder. The type of medication used should also be chosen for your specific needs. Your doctor may prescribe a low dose and then gradually increase the dose. In this way, he or she can evaluate the how well the drug is working and reduce your risk of experiencing side effects. Your doctor should discuss with you the risks and benefits of using medications. Common medications used include:
Anticholinergic medications (These medications control muscle spasms in the bladder):
- Oxybutynin (Ditropan®), oxybutynin XL (Ditropan XL®), oxybutynin TDDS (Oxytrol®)
- Propantheline (Pro-Banthine®)
- Dicyclomine (Antispas®, Bentyl®, Di-Spaz®, Dibent®, Or-Tyl®, Spasmoject®)
- Tolterodine (Detrol®)
- Solifenacin (Vesicare®)
- Fesoterodine (Toviaz®)
- Darifenacin (Enablex®)
- Trospium (Sanctura XR®)
- Oxybutinin Gel (Gelnique®)
- Antidepressant medication - Imipramine (Norfranil, Tipramine, Trofranil)
- Empty your bladder regularly, especially before physical activity.
- Avoid drinking caffeine or a lot of fluid before activities.
- Avoid lifting heavy objects.
- Practice Kegel exercises (explained later in this document).
- Practice timed voidings. (Go to the bathroom on a regular schedule rather than waiting for the urge.)
- Aids used with self-help techniques
- Perineometer: This device is used to measure the force of the sphincter muscles.
- Vaginal cones (for women): The woman inserts a tampon-shaped cone into the vagina and holds it in place by contracting the pelvic muscles. As the muscles get stronger, the weight of the cone is increased.
- Electrical stimulation: Mild electrical impulses are used to stimulate contractions of the pelvic floor muscles. Devices for electrical stimulation can be implanted near the spine or activated by the urethra, vagina, or rectum (non-implanted devices). Electrical stimulation can be used for incontinence that does or does not involve neurological problems.
- Biofeedback: In biofeedback, devices are used to help you see the strength of your contractions. Biofeedback can help you learn how to perform Kegel exercises.
Your doctor may recommend surgery if other treatments fail to improve your symptoms of overactive bladder. Surgical procedures for urge incontinence can be used to:
- Increase the storage capacity of the bladder (hydro-distention)
- Limit nerve impulses to the control muscles (denervation) with use of off label botulinum toxin injections into the bladder
- Divert the flow of urine
- Modulate the nerves to bladder/penis (neuromodulation) as outpatient therapy that is quite effective and minimally invasive
Several devices and procedures help reposition and stabilize the bladder and urethra. A pessary is a semi-rigid ring placed in the vagina to reposition the urethra and reduce stress incontinence leakage. Bulking substances such as collagen (fat) or specially formulated artificial substances may be injected to provide support and bulk around the urethra. These substances compress the urethra near the bladder outlet to reduce the effects of stress incontinence. The procedure may need to be repeated at annually or more frequent intervals.
Several other surgical procedures have been shown to have high success rates. Stress incontinence often results from the bladder losing support and gradually dropping toward the vagina. The bladder can be returned to a more normal position with sutures that stabilize it by attaching it to nearby structures such as muscle, stable tissue or bone. Another procedure that provides bladder support involves placing a pubo-vaginal sling, a sort of hammock, beneath the bladder. The sling is sutured to adjacent structures. Excellent results with the pubo-vaginal sling have been achieved in women with stress urinary incontinence.
An artificial sphincter is a novel device that mimics the musculature of the sphincter. It is a surgically implanted ring that encircles the urethra. It can be manually inflated to close around the urethra and prevent urine leakage. Sphincter implantation is not a common procedure but one that can be successfully employed in carefully selected patients.
Indwelling catheterization is a procedure employed in women whose bladder fails to empty completely as a result of loss of muscle tone, prior surgery, or spinal cord injury. The catheter (thin tube) is inserted in the urethra and allowed to drain into a bag attached to the leg.
This range of therapies briefly described here should suggest to the reader a single therapy is seldom employed to treat the UI. Instead combinations of these therapies are tailored to meet the condition and needs of the patient after extensive consultation, usually with several specialists in the varying aspects of UI therapy.
Treatments for stress incontinence:
Self-help techniques and aids, as described above, can be used to treat mild stress incontinence.
Bulking agents are substances that are injected into the lining of the urethra. They increase the size of the lining of the urethra, which creates resistance against the flow of urine. Collagen is one bulking agent commonly used.
When these methods fail, surgery may be an option and is highly effective and durable. Surgery is now minimally invasive and performed on an outpatient basis in most cases without the need for a catheter after surgery. Surgery can be used to:
- Increase resistance in the urethra
- Implant an artificial sphincter
- Tighten the pelvic floor muscles
- Change pressure within the urethra using an implant device
- Minimize leakage with exercise and activity
- Allow one to resume most normal activities within a couple weeks after surgery
- Allow for a long lasting result
- Selectively help in patients with both overactive bladder and stress incontinence combined (mixed incontinence)
What are kegel exercises?
Kegel exercises, also called pelvic floor exercises, help strengthen the muscles that support the bladder, uterus, and bowels. By strengthening these muscles, you can reduce or prevent problems such as leaking urine.
How do I perform Kegel exercises?
Imagine you are trying to stop the flow of urine or trying not to pass gas. When you do this, you are contracting the muscles of the pelvic floor and are practicing Kegel exercises. While doing Kegel exercises, try not to move your leg, buttock, or abdominal muscles. In fact, no one should be able to tell that you are doing Kegel exercises.
How often should I do Kegel exercises?
Kegel exercises should be done every day. We recommend doing five sets of Kegel exercises a day. Each time you contract the muscles of the pelvic floor, hold for a slow count of five and then relax. Repeat this ten times for one set of Kegels.
Additional muscle strengthening exercises for urinary incontinence in women
Electrical stimulation can also strengthen muscles in cases of stress and urge incontinence. This therapeutic approach, also called transcutaneous electrical nerve stimulation (TENS), temporarily places small electrodes on the surface of the skin adjacent to targeted muscles or inside vagina or rectum. Minute pulses of electricity stimulate pulses of muscle contraction and strengthens them. Another form of electrical therapy involves placing a small sacral nerve stimulator (a sort of pacemaker about the size of a stopwatch), beneath the skin with wires leading to the sacral nerve in the lower back. Pulses from the stimulator offset hyperactive nerve activity around the bladder. The sensation has been described as a slight pulling in the pelvic area.
Biofeedback involves what might be called 'electronic training wheels'. Electronic sensing devices are placed to record nerve impulses and muscle contractions. These offer the patient more information concerning voiding impulses than she would normally be aware of. By monitoring these impulses and learning to control them, additional control over urination can be gained.