Treatment for Urinary Incontinence

Common tests and processes for urinary incontinence include: 

Bladder diary:

  Your doctor may ask you to keep a bladder diary for several days. You record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes.

Urinalysis: A sample of your urine is sent to a laboratory, where it's checked for signs of infection, traces of blood or other abnormalities.

Blood test: Your doctor may have a sample of your blood drawn and sent to a laboratory for analysis. Your blood is checked for various chemicals and substances related to causes of incontinence.

Specialized testing:

If further information is needed, you may undergo additional testing, including:

• Postvoid residual (PVR) measurement: For this procedure, you're asked to urinate (void) into a container that measures urine output. Then your doctor checks the amount of leftover (residual) urine in your bladder using a catheter or ultrasound test. A large amount of leftover urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles.

•  Pelvic ultrasound:Ultrasound also may be used to view other parts of your urinary tract or genitals to check for abnormalities.

• Stress test: For this test, you're asked to cough vigorously or bear down as your doctor examines you and watches for loss of urine.

• Urodynamic testing: These tests measure pressure in your bladder when it's at rest and when it's filling and it's an important tool for distinguishing the type of incontinence you have.

• Cystogram: These images help reveal problems with your urinary tract.

• Cystoscopy. A thin tube with a tiny lens (cystoscope) is inserted into your urethra. During cystoscopy, your doctor can check for — and potentially remove — abnormalities in your urinary tract.

Treatments and drugs:

Treatment for urinary incontinence depends on the type of incontinence, the severity of your problem and the underlying cause. Your doctor will recommend the approaches best suited to your condition. A combination of treatments may be needed. 

In most cases, your doctor will suggest the least invasive treatments first, so you'll try behavioral techniques and physical therapy first and move on to other options only if these techniques fail.

 Behavioral techniques;

 Behavioral techniques and lifestyle changes work well for certain types of urinary incontinence. They may be the only treatment you need. 

Bladder training: 

•  Your doctor may recommend bladder training — alone or in combination with other therapies — to control urge and other types of incontinence. Bladder training involves learning to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate.

•  The goal is to lengthen the time between trips to the toilet until you're urinating every two to four hours.

• Bladder training may also involve double voiding — urinating, then waiting a few minutes and trying again. This exercise can help you learn to empty your bladder more completely to avoid overflow incontinence. In addition, bladder training may involve learning to control urges to urinate. When you feel the urge to urinate, you're instructed to relax — breathe slowly and deeply — or to distract yourself with an activity.

Scheduled toilet trips: 

 This means timed urination — going to the toilet according to the clock rather than waiting for the need to go. Following this technique, you go to the toilet on a routine, planned basis — usually every two to four hours.

Fluid and diet management. 

 In some cases, you can simply modify your daily habits to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity are other lifestyle changes that can eliminate the problem.

Physical therapy:

Urinary Incontinence Treatment with Exercise:

• Anti-incontinence exercises{kegel exercises} are designed to strengthen the pelvic floor muscles (the muscles that hold the bladder in place). These muscles are also called the levator ani muscles. They are named levator muscles because they hold (elevate) the pelvic organs in their proper place. When the levator muscles weaken, the pelvic organs move out of their normal place (prolapse), and stress incontinence results.

 Physical therapy is usually the first step to treat stress incontinence caused by weakened pelvic muscles. If aggressive physical therapy does not work, surgery may be necessary.

• There are special exercises to strengthen the pelvic muscles. Exercises can be done alone or with vaginal cones, biofeedback therapy, or electrical stimulation. In general, exercise is a safe and effective treatment that should be used first to treat urge and mixed incontinence.

• It is important that you exercise the correct muscles. Your doctor may refer you to a continence advisor or physiotherapist for advice on the exercises. The sort of exercises are as follows:

Learning to exercise the right muscles:

• Sit in a chair with your knees slightly apart. Imagine you are trying to stop wind escaping from your anus (back passage). You will have to squeeze the muscle just above the entrance to the anus. You should feel some movement in the muscle. Don't move your buttocks or legs.

• Now imagine you are passing urine and are trying to stop the stream. You will find yourself using slightly different parts of the pelvic floor muscles to the first exercise (ones nearer the front). These are the ones to strengthen.

Doing the exercises:

• You need to do the exercises every day.
• Sit, stand or lie with your knees slightly apart. Slowly tighten your pelvic floor muscles under the bladder as hard as you can. Hold to the count of five, then relax. Repeat at least five times. These are called slow pull-ups.
• Then do the same exercise quickly for a second or two. Repeat at least five times. These are called fast pull-ups.
• Keep repeating the five slow pull-ups and the five fast pull-ups for five minutes.
• Aim to do the above exercises for about five minutes at least three times a day, and preferably 6-10 times a day.
• Ideally, do each five-minute bout of exercise in different positions. That is, sometimes when sitting, sometimes when standing, and sometimes when lying down.
• As the muscles become stronger, increase the length of time you hold each slow pull-up. You are doing well if you can hold each slow pull-up for a count of 10 (about 10 seconds).
• Do not squeeze other muscles at the same time as you squeeze your pelvic floor muscles. For example, do not use any muscles in your back, thighs, or buttocks.
• In addition to the times you set aside to do the exercises, try to get into the habit of doing exercises whilst going about everyday life. For example, when answering the phone, when washing up, etc.

After several weeks the muscles will start to feel stronger. You may find you can squeeze the pelvic floor muscles for much longer without the muscles feeling tired.

It takes time, effort and practice to become good at these exercises. It is advised that you do these exercises for at least three months to start with. You should start to see benefits after a few weeks. However, it often takes 8-20 weeks for most improvement to occur. After this time you may be cured from stress incontinence. If you are not sure that you are doing the correct exercises, ask a doctor, physiotherapist or continence advisor for advice.

If possible, continue exercising as a part of everyday life for the rest of your life to stop the problem recurring. Once incontinence has gone, you may only need to do 1-2 five-minute bouts of exercise each day to keep the pelvic floor muscles strong and toned up, and incontinence away.

Other ways of exercising pelvic floor muscles

Sometimes a continence advisor or physiotherapist will advise extra methods if you are having problems or need some extra help performing the pelvic floor exercises. These are in addition to the above exercises. For example:

• Electrical stimulation. Sometimes a special electrical device is used to stimulate the pelvic floor muscles with the aim of making them contract and become stronger.

• Biofeedback. This is a technique to help you make sure that you exercise the correct muscles. For this, a physiotherapist or continence advisor inserts a small device into your vagina when you are doing the exercises. When you squeeze the right muscles, the device makes a noise (or some other signal such as a display on a computer screen) to let you know that you are squeezing the correct muscles

• Vaginal cones. These are small plastic cones that you put inside your vagina for about 15 minutes, twice a day. The cones come in a set of different weights. At first, the lightest cone is used. You need to use your pelvic floor muscles to hold the cone in place. So, it helps you to exercise your pelvic floor muscles. Once you can hold on to the lightest one comfortably, you move up to the next weight, and so on.

• Other devices. There are various other devices that are sold to help with pelvic floor exercises. Basically, they all rely on placing the device inside the vagina with the aim of helping the pelvic muscles to exercise and squeeze. There is little research evidence to show how well these devices work. It is best to get the advice from a continence advisor or physiotherapist before using any. One general point is that if you use one, it should be in addition to, not instead of, the standard pelvic floor exercises described above.

Pelvic floor exercises if you do not have incontinence:

The type of exercises are exactly the same as above. If you are not used to pelvic floor exercises then perhaps do the exercises as often as described above for the first three months or so. This will strengthen up the pelvic floor muscles. Thereafter, a five-minute spell of exercises once or twice a day should keep the muscles strong and toned up which may help to prevent incontinence from developing in later life.

• For urge incontinence, pelvic floor muscle exercises are used to retrain the bladder. When one contracts the urethral sphincter, the bladder automatically relaxes, so the urge to urinate eventually goes away. Strong contractions of the pelvic floor muscles suppress bladder contractions. Whenever an individual feels urinary urgency, they can try to stop the feeling by strongly contracting the pelvic floor muscles. These steps may give the person more time to walk slowly to the bathroom with urinary control.
• This technique may be used for stress and urge symptoms (mixed incontinence).

Medications

Often, medications are used in conjunction with behavioral techniques. Drugs commonly used to treat incontinence include:

Anticholinergics. These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Several drugs fall under this category, including oxybutynin (Ditropan), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura). Possible side effects of these medications include dry mouth, constipation, blurred vision and flushing.

Topical estrogen. Applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate tissues in the urethra and vaginal areas. This may reduce some of the symptoms of incontinence.

Imipramine. Imipramine (Tofranil) is a tricyclic antidepressant that may be used to treat mixed — urge and stress — incontinence.

Duloxetine. The antidepressant medication duloxetine (Cymbalta) is sometimes used to treat stress incontinence.

Medical devices

Several medical devices are available to help treat incontinence. They're designed specifically for women and include:

Urethral insert. This small tampon-like disposable device inserted into the urethra acts as a plug to prevent leakage. It's usually used to prevent incontinence during a specific activity, but it may be worn throughout the day. Urethral inserts aren't meant to be worn 24 hours a day. They are available by prescription and may work best for women who have predictable incontinence during certain activities, such as playing tennis. The device is inserted before the activity and removed before urination.

Pessary (PES-uh-re). Your doctor may prescribe a pessary — a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage.  You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.

Interventional therapies

Bulking material injections. 

 Bulking agents are materials, such as carbon-coated zirconium beads (Durasphere), calcium hydroxylapatite (Coaptite) or polydimethylsiloxane (Macroplastique), that are injected into tissue surrounding the urethra. This helps keep the urethra closed and reduce urine leakage. The procedure — usually done in a doctor's office — requires minimal anesthesia and takes about five minutes. The downside is that repeat injections are usually needed.

Botulinum toxin type A. 

Injections of onabotulinumtoxinA (Botox) into the bladder muscle may benefit people who have an overactive bladder. Researchers have found this to be a promising therapy, but the Food and Drug Administration (FDA) has not yet approved this drug for incontinence.

Nerve stimulators. 

 Sacral nerve stimulators can help control your bladder function. The device,which resembles a pacemaker, is implanted under the skin in your buttock. A wire from the device is connected to a sacral nerve — an important nerve in bladder control that runs from your lower spinal cord to your bladder. Through the wire, the device emits painless electrical pulses that stimulate the nerve and help control the bladder.

 Another device, the tibial nerve stimulator, is approved for treating overactive bladder symptoms. Instead of directly stimulating the sacral nerve, this device uses an electrode placed underneath the skin to deliver electrical pulses to the tibial nerve in the ankle. These pulses then travel along the tibial nerve to the sacral nerve, where they help control overactive bladder symptoms.

Surgery:

If other treatments aren't working, several surgical procedures have been developed to fix problems that cause urinary incontinence.

Some of the commonly used procedures include:

Sling procedures. 

A sling procedure uses strips of your body's tissue, synthetic material or mesh to create a pelvic sling or hammock around your bladder neck and urethra. The sling helps keep the urethra closed, especially when you cough or sneeze. There are many types of slings, including tension-free, adjustable and conventional.

Bladder neck suspension. 

 This procedure is designed to provide support to your urethra and bladder neck — an area of thickened muscle where the bladder connects to the urethra. It involves an abdominal incision, so it's done using general or spinal anesthesia.

Artificial urinary sphincter. 

 This small device is particularly helpful for men who have weakened urinary sphincters from treatment of prostate cancer or an enlarged prostate gland. Shaped like a doughnut, the device is implanted around the neck of your bladder. The fluid-filled ring keeps your urinary sphincter shut tight until you're ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to flow.

• Absorbent pads and catheters

If medical treatments can't completely eliminate your incontinence — or you need help until a treatment starts to take effect — you can try products that help ease the discomfort and inconvenience of leaking urine.

Pads and protective garments:Various absorbent pads are available to help you manage urine loss. 

Catheter:

 If you're incontinent because your bladder doesn't empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder (self-intermittent catheterization). This should give you more control of your leakage, especially if you have overflow incontinence. You'll be instructed on how to clean these catheters for safe reuse.

Lifestyle and home remedies

• Protecting your skin

•  Problems with urine leakage may require you to take extra care to prevent skin irritation. Some things you can do to protect your skin include:

• Use a washcloth to clean yourself.

• Allow your skin to air dry.

• Avoid frequent washing and douching because these can overwhelm your body's natural defenses against bladder infections.

• Consider using a barrier cream, such as petroleum jelly or cocoa butter, to protect your skin from urine.

• Making the toilet more convenient

• If you have urge incontinence or nighttime incontinence:

                             Move any rugs or furniture you might trip over or collide with on the way to the toilet.

• Use a night light to illuminate your path and reduce your risk of falling.

• If you have functional incontinence, possible changes may include:

                              Keeping a bedpan in your bedroom

                              Installing an elevated toilet seat

                             Adding a bathroom in a more convenient location

                             Widening an existing bathroom doorway

Coping and support

If you're embarrassed about having a bladder control problem, you may try to cope on your own — wearing absorbent pads, carrying extra clothes, avoiding going out. You may even cut back on drinking liquids — and risk dehydration — to avoid wetting episodes.

But there are better ways to manage urinary incontinence, and effective treatments are available. That's why it's important to see your doctor and ask about treatment. You'll be on your way to regaining an active and confident life — and control of your bladder.

Prevention

Urinary incontinence is not always preventable. However, you may be able to decrease your risk of incontinence with these steps:

• Maintain a healthy weight. If you're overweight, reaching a healthy weight may help.

• Don't smoke. Get help with quitting if you do smoke.

• Practice Kegel exercises. Doctors often advise pregnant women to do Kegel exercises during pregnancy as a preventive measure.

• Avoid bladder irritants. Avoiding or limiting certain foods and drinks may help prevent or limit urinary incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or forgoing caffeine-containing drinks may be all that you need to do.

• Eat more fiber. Including more fiber in your diet or taking fiber supplements can help prevent constipation, a risk factor for urinary incontinence.

• Exercise. Physical activity reduces your risk of developing incontinence.