Treatments for Urinary Incontinence


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Treatment list for Urinary Incontinence: The list of treatments mentioned in various sources for Urinary Incontinence includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Treatments of Urinary Incontinence discussion: It depends on what kind of bladder control problem you have. Hormone medicines are only one treatment. Your health care team may also recommend some of the following:

  • limiting caffeine
  • exercising pelvic muscles
  • training the bladder to hold more urine.
If these simple treatments do not work, your health care team may have you try something different. These treatments might include

  • biofeedback
  • electrical stimulation of pelvic muscles
  • a device inserted in the vagina to hold up the bladder
  • a device inserted directly into the urethra to block leakage
  • surgery to lift a sagging bladder into a better position.
1

Incontinence is treatable and often curable at all ages. If you experience incontinence, you may feel embarrassed. It may help you to remember that loss of bladder control can be treated. You will need to overcome your embarrassment and see a doctor to learn if you need treatment for an underlying medical condition. 2

Exercises

Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage. Women of all ages can learn and practice these exercises, which are taught by a health care professional.

Most Kegel exercises do not require equipment. However, one technique involves the use of weighted cones. For this exercise, you stand and hold a cone-shaped object within your vagina. You then substitute cones of increasing weight to strengthen the muscles that help keep the urethra closed.

Electrical Stimulation

Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.

Biofeedback

Biofeedback uses measuring devices to help you become aware of your body's functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Timed Voiding or Bladder Training

Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Biofeedback and muscle conditioning--known as bladder training--can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.

Medications

Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally.

Some of these medications can produce harmful side effects if used for long periods. In particular, estrogen therapy has been associated with an increased risk for cancers of the breast and endometrium (lining of the uterus). Talk to your doctor about the risks and benefits of long-term use of medications.

Pessaries

A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.

Implants

Implants are substances injected into tissues around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. Collagen (a fibrous natural tissue from cows) and fat from the patient's body have been used. Implants can be injected by a doctor in about half an hour using local anesthesia.

Implants have a partial success rate. Injections must be repeated after a time because the body slowly eliminates the substances. Before you receive collagen, a doctor must perform a skin test to determine whether you would have an allergic reaction to the material.

Surgery

Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success.

Most stress incontinence results from the bladder dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.

For severe cases of stress incontinence, the surgeon may secure the bladder with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage.

In rare cases, a surgeon implants an artificial sphincter, a doughnut-shaped sac that circles the urethra. A fluid fills and expands the sac, which squeezes the urethra closed. By pressing a valve implanted under the skin, you can cause the artificial sphincter to deflate. This removes pressure from the urethra, allowing urine from the bladder to pass.

Catheterization

If you are incontinent because your bladder never empties completely (overflow incontinence) or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. Catheters may be used once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use a long-term (or indwelling) catheter, you should watch for possible urinary tract infections.

Other Procedures

Many women manage urinary incontinence with pads that catch slight leakage during activities such as exercising. Also, you often can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.

Finally, many women who could be treated resort instead to wearing absorbent undergarments, or diapers--especially elderly women in nursing homes. This is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are an elderly woman, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding, pelvic muscle exercises, and electrical stimulation before resorting to absorbent pads or undergarments. 2

Treatments include waiting, dietary modification, moisture alarms, medications, and bladder training. 3

Nighttime incontinence may be treated by increasing ADH levels. The hormone can be boosted by a synthetic version known as desmopressin, or DDAVP. Users, including children, spray a mist containing desmopressin into their nostrils, where the drug enters the bloodstream. Researchers are developing a pill version of this drug.

Another medication, called imipramine, is also used to treat sleepwetting. It acts on both the brain and the urinary bladder. Unfortunately, total dryness with either of the medications available is achieved in only about 20 percent of patients.

If a young person experiences incontinence resulting from an overactive bladder, a doctor might prescribe a medicine that helps to calm the bladder muscle. This medicine controls muscle spasms and belongs to a class of medications called anticholinergics.3

Bladder training consists of exercises for strengthening and coordinating muscles of the bladder and urethra, and may help the control of urination. These techniques teach the child to anticipate the need to urinate and prevent urination when away from a toilet. Techniques that may help nighttime incontinence include

  • Determining bladder capacity


  • Stretching the bladder (delaying urinating)


  • Drinking less fluid before sleeping


  • Developing routines for waking up
Unfortunately, none of the above has demonstrated proven success.

Techniques that may help daytime incontinence include

  • Urinating on a schedule, such as every 2 hours (this is called timed voiding)

  • Avoiding caffeine and the artificial sweetener aspartame

  • Following suggestions for healthy urination, such as relaxing muscles and taking your time
3

At night, moisture alarms can wake a person when he or she begins to urinate. These devices include a water-sensitive pad worn in pajamas, a wire connecting to a battery driven control, and an alarm that sounds when moisture is first detected. For the alarm to be effective, the child must awaken or be awakened as soon as the alarm goes off. This may require having another person sleep in the same room to awaken the bedwetter. 3

Exercising your pelvic floor muscles for just 5 minutes, three times a day can make a big difference to your bladder control. Exercise strengthens muscles that hold the bladder and many other organs in place. 4

You should tighten the two major muscles that stretch across your pelvic floor. They are the "hammock" muscle and the "triangle" muscle. Here are three methods to check for the correct muscles.
You can make these pelvic floor muscles stronger with a few minutes of exercise every day.
  1. Try to stop the flow of urine when you are sitting on the toilet. If you can do it, you are using the right muscles.

  2. Imagine that you are trying to stop passing gas. Squeeze the muscles you would use. If you sense a "pulling" feeling, those are the right muscles for pelvic exercises.

  3. Lie down and put your finger inside your vagina. Squeeze as if you were trying to stop urine from coming out. If you feel tightness on your finger, you are squeezing the right pelvic muscle.
4

Your treatment will depend on the type of bladder control problem you have. Some treatments are simple. Others are more complicated. The simplest treatments for women include pelvic muscle exercises. You can learn simple exercises that can strengthen the muscles near the urethra. These are called pelvic muscle exercises or Kegel exercises and take only a few minutes a day. Also, bladder training, weight loss and reduction of foods with caffeine and alcohol in your diet may all help some types of incontinence. Another level of treatment for muscle therapy may include electrical stimulation to make the muscles stronger and tighter, or biofeedback which takes the guesswork out of pelvic muscle exercise. A therapist places a patch over the muscles. A wire connects the patch to a TV screen. You watch the screen to see if you are exercising the right muscles. The therapist will help you. Soon you learn to control these muscles without the patch or screen. Then, there are medical treatments. Certain drugs can tighten or strengthen urethral and pelvic floor muscles. Other medicines can calm overactive bladder muscles. There is the option of collagen injections as well: Collagen (CALL-uh-jen) is a natural substance like fat. It can be injected into the tissue around your urethra to add bulk and keep your sphincter muscles tightly closed. One drawback to this treatment is that collagen breaks down after several months, so you may need to have injections repeated. Devices can also be inserted into the urethra or pads placed over the urethra to block urine flow.

Some bladder control problems can be solved by surgery, depending on what is causing the problem. In most cases, the surgeon changes the position of the bladder and urethra. After the operation, the bladder control muscles work better. 5

If you are having trouble with incontinence, see your doctor. Even if it can't be completely cured, modern products and ways of managing incontinence can ease its discomfort and inconvenience.6

Treatment of urinary incontinence should be designed to meet your needs. As a general rule, the least dangerous procedures should be tried first. The many options include:

  • Behavioral techniques such as pelvic muscle exercises, biofeedback, and bladder training can help control urination. These techniques can help you sense your bladder filling and help delay voiding until you can reach a toilet.
  • A doctor can prescribe medicines to treat incontinence. However, these drugs may cause side effects such as dry mouth, eye problems, or urine buildup.
  • Sometimes surgery can improve or cure incontinence if it is caused by a structural problem such as an abnormally positioned bladder or blockage due to an enlarged prostate. Implanting devices that replace or aid the muscles controlling urine flow has been tried in people with incontinence.
6

If your incontinence cannot be cured, it can be managed in several ways.

  • You can get special absorbent underclothing that is no more bulky than normal underwear and can be worn easily under everyday clothing.
  • A flexible tube (indwelling catheter) can be put into the urethra (the canal that carries the urine from the bladder) to collect urine in a container. Long-term catheterization--although sometimes necessary--creates many problems, including urinary infections. Men have the choice of an external collecting device. This is fitted over the penis and connected to a drainage bag.

Remember, under a doctor's care, incontinence can be treated and often cured. Even if treatment is not fully successful, careful management can help.6

Footnotes:
1. excerpt from Menopause and Bladder Control: NIDDK
2. excerpt from Urinary Incontinence in Women: NIDDK
3. excerpt from Urinary Incontinence in Children: NIDDK
4. excerpt from Exercising Your Pelvic Muscles: NIDDK
5. excerpt from Urinary Incontinence: NWHIC
6. excerpt from Urinary Incontinence - Age Page - Health Information: NIA
Last revision: Oct 30, 2003

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