Urinary Incontinence
How is it treated?
Even though urinary incontinence has no complete cure, it can often be managed adequately with behavioral techniques, medications, surgery, or a combination of therapies. The main goal of treatment is to control bladder problems so that they do not interfere with daily activities. The correct assessment of the type of urinary incontinence by an urologist (a physician who specializes in the urinary system) is very important. A health care professional will then decide which of the following treatment options is best for the individual and the type of incontinence.
Behavioral Techniques
- Bladder training/retraining: A diary can be used to record the volume of fluid intake, the number of urinations, and urinary accidents on a daily basis. The diary then helps a physician set ?timed intervals? for urination, so the individual establishes regular bladder emptying times. The goal is urination only every 3 to 4 hours while the individual is awake.
- Pelvic floor exercises (also known as Kegel exercises): Exercising focuses primarily on strengthening the pelvic floor muscles that support the urethra and bladder. The assistance of a health care professional may be required to locate the correct muscles prior to beginning exercises. Generally, pelvic floor muscles are tightened (contracted) for 10 seconds, then relaxed for 10 seconds. This procedure is repeated 10 times, at least three times a day. When performed properly, these exercises significantly improve urinary incontinence, by about 50% to 80%. Patients with stress incontinence or urge incontinence benefit the most from pelvic floor exercises.
- Fluid and diet management: Reducing the consumption of bladder irritants such as acidic fruits and vegetables, alcohol, carbonated beverages, chocolate, coffee, and tea may relieve urinary incontinence for some individuals. However, water intake may need to be increased, so that urine is less concentrated, which helps reduce bladder irritation.
Devices
The most common external devices used by individuals with any type of incontinence are absorbent pads and disposable undergarments that soak up any urine leakage. For men, small disposable pads of absorbent material enclosed in waterproof coverings are available. Called drip collectors or penis caps, these pads are worn on the penis to collect small urine leaks. For larger amounts of urine, men may also use a condom catheter - a sheath that is attached to the penis. A tube at the end of the sheath leads to a urine storage bag, which can be emptied several times a day. Some men may wear padded clamps or inflatable rings that fit over the penis and compress the urethra. When closed, these compression devices stop urine from leaking. They must be opened for urination.
Internal devices are also used to control incontinence. Particularly for individuals with functional incontinence, internal catheters are common. The catheter is a narrow tube inserted into the bladder to drain urine directly into a collection pouch. The pouch is then emptied. For women, a pessary may be inserted into the vagina to help support the bladder. Usually used to stabilize the uterus, a pessary is a small, soft device similar to a contraceptive diaphragm or sponge.
Surgery
When other therapy fails, or when incontinence symptoms become severe, surgical treatment may be necessary.
For men with stress incontinence, several different types of minimally invasive surgery are used to insert collagen or another bulking agent, graft tissue, or implant an artificial sphincter. The most common surgical option for women with stress incontinence is called a sling procedure, in which donor or synthetic tissue is attached to the urethra. A more invasive technique involves supporting the bladder by attaching the vagina to the pubic bone.
For urge incontinence, both men and women may benefit from a bladder pacemaker. Similar to a heart pacemaker, the bladder pacemaker uses a small, implanted electrical stimulator that can be used to regulate bladder function. For severe urge incontinence, a procedure called augmentation cystoplasty uses a piece of the patient?s intestine to enlarge the bladder.
Surgery for overflow incontinence consists mainly of removing an obstruction of the urethra. This type of surgery is common for men with enlarged prostates.
Drug classes used to treat Urinary Incontinence Anticholinergics for Urinary Incontinence Antispasmodics Miscellaneous Agents for Urinary Incontinence Topical Estrogens
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How is it treated?
