Treatment of urinary incontinence

 

What is urinary incontinence?

“Urinary incontinence” is the medical term for when a person leaks urine or loses bladder control. Often it is called just “incontinence.”

Incontinence is a very common problem, but it is not a normal part of aging. If you have this problem, you do not have to “just live with it.” There are treatments and things you can do on your own to stop or reduce urine leakage.

 

What are the symptoms of incontinence?

There are different types of incontinence. Each causes different symptoms. The 3 most common types are:

 Stress incontinence: People with stress incontinence leak urine when they laugh, cough, sneeze, or do anything that “stresses” the belly. Stress incontinence is most common in women, especially those who have had a baby.

 Urgency incontinence: People with urgency incontinence feel a strong need to urinate all of a sudden. Urgency incontinence is also known as urge incontinence. Often the “urge” is so strong that they can’t make it to the bathroom in time. (If you have these sudden urges but do not leak urine, you might have an “overactive bladder.” That can also be treated.)

 Mixed incontinence: People with mixed incontinence have symptoms of both stress and urgency incontinence.

 

Is there anything I can do on my own to feel better?

Yes. Here are some steps that can help reduce urine leaks:

  •  Reduce the amount of liquid you drink, especially a few hours before bed.
  •  Cut down on any foods or drinks that make your symptoms worse. Some people find that alcohol, caffeine, or spicy or acidic foods irritate the bladder.
  •  Lose weight, if you are overweight.
  •  If you have diabetes, keep your blood sugar as close to normal as possible.
  •  If you take medicines called diuretics, plan ahead. These medicines increase the need to urinate. Take them when you know you will be near a bathroom for a few hours.

 

These techniques can also help improve bladder control:

  •  Bladder retraining: During bladder retraining, you go to the bathroom at scheduled times. For instance, you might decide that you will go every hour. You would make yourself go every hour, even if you didn’t feel like you needed to. And you would try to wait until a whole hour had passed if you needed to go sooner. Then, once you got used to going every hour, you would increase the amount of time you waited in between bathroom visits. Over time, you might be able to “retrain” your bladder to wait 3 or 4 hours between bathroom visits.
  •  Pelvic muscle exercises: Pelvic muscle exercises strengthen the muscles that control the flow of urine. These exercises can help, but people often do them wrong. Ask your doctor or nurse how to do them right.
  • Should I see my doctor or nurse? — Yes. Your doctor or nurse can find out what might be causing your incontinence. He or she can also suggest ways to relieve the problem.

When you speak to your doctor or nurse, ask if any of the medicines you take could be causing your symptoms. Some medicines can cause incontinence or make it worse.

 

How is incontinence treated?

The treatment options differ depending on what type of incontinence you have, and whether you are a man or a woman. Some of the treatment options include:

  •  Kegels exercise
  •  Medicines to relax the bladder
  •  Surgery to repair the tissues that support the bladder or to improve the flow of urine (figure 1)
  •  Electrical stimulation of the nerves that relax the bladder

 

What are pelvic muscle exercises?

Pelvic muscle exercises are exercises that strengthen the muscles that control the flow of urine and bowel movements. These exercises are also known as “Kegel” exercises. They can help keep you from leaking urine, gas, or bowel movements, if leaks are a problem for you. They can also help with a condition that affects women called “pelvic organ prolapse.” In women who have pelvic organ prolapse, the organs in the lower belly drop down and press against or bulge into the vagina.

How do I learn how to do Kegel exercises? — First ask your doctor or nurse how to do them right. He or she can help you get started.

You will need to learn which muscles to tighten. It is sometimes hard to figure out the right muscles.

A woman might learn to do Kegel exercises by:

 Putting a finger inside her vagina and squeezing the muscles around her finger; or

 Pretending that she is sitting on a marble and has to pick up the marble using her vagina

A man might learn to do Kegels by tightening his butt muscles as if he were holding back gas.

 

Both men and women can also learn to do Kegel exercises by stopping and starting the flow of urine. If you do this, make sure to do this only once or twice to figure out the correct muscles. Some doctors think you should not do this at all, because if you get in the habit of doing it, it could damage your bladder.

No matter how you learn to do Kegel exercises, the important thing to know is that the muscles involved are not in your belly or your thighs.

After you learn which muscles to tighten, you can do the exercises in any position (sitting in a chair or lying down). You do not need to do them while you are in the bathroom.

How often should I do the exercises? — Do the exercises 3 times a day, on 3 or 4 days a week. Each time, flex your muscles 8 to 12 times, and hold them tight for 6 to 8 seconds each time you tighten. Keep up this routine for at least 3 to 4 months. You will probably see results, but it might take a little time.

 

How do Kegel exercises help?

Kegel exercises can help:

  •  Reduce urine leaks in people who have “stress incontinence,” which means they leak urine when they cough, laugh, sneeze, or strain
  •  Control sudden urges to urinate that happen to people with “urgency incontinence.” (Urgency incontinence is also known as urge incontinence.)
  •  Control the release of gas or bowel movements
  •  Reduce pressure or bulging in the vagina caused by pelvic organ prolapse. (If you have a bulge in the vagina, see your doctor or nurse to find out the cause.)

 

 What is surgery to treat stress urinary incontinence in women?

 Surgery is 1 treatment for women with a condition called “stress urinary incontinence.” People with this condition leak urine when they laugh, cough, sneeze, or do anything that puts pressure on the belly.

There are other treatments for stress urinary incontinence besides surgery. But if these treatments do not work well or you don’t want to try them, you might have surgery.

How do doctors do surgery to treat stress urinary incontinence in women? — Most surgery to treat stress urinary incontinence in women is “minimally invasive” surgery. This means the doctor makes smaller cuts than in regular surgery and uses small tools that he or she controls from the outside. But doctors can also do “open” surgery. This means they make a cut big enough to work on the body directly from the outside.

Are there different types of surgery to treat stress urinary incontinence? — Yes. There are many types. They include:

  •  A “sling procedure” – A sling is a small piece of material that goes around the urethra. (The urethra is the tube that carries urine out of the body.) There are different types of slings, but they all give the urethra support to help keep it from leaking urine.  The sling can be made of artificial mesh or tissue from the woman’s body.
  •  A procedure called the “Burch procedure” or “retropubic colposuspension” – In this procedure, a doctor attaches the tissue around the urethra to strong bands of tissue inside the belly. This procedure can be “minimally invasive” surgery (several small cuts) or “open” surgery (1 large cut).
  •  An injection (shot) of material next to the urethra – The material makes the area around the urethra thicker. This helps support the urethra and keep urine from leaking out. This treatment is mostly for women who still have stress incontinence after they have already had surgery. It is usually done in a doctor’s office.

What are the benefits of surgery?

The main benefit is that surgery can often fix stress incontinence when other treatments do not.

 

What are the risks of surgery?

The risks of surgery are different depending on:

 What type of surgery you have

 Your age and overall health

The risks of surgery include:

  •  Problems from surgery, such as bleeding, infection, or a tear in the bladder
  •  Trouble getting all the urine out when urinating
  •  Stress incontinence after surgery – Some women might still have stress incontinence after surgery.
  •  Urgency incontinence, also called “urge incontinence” or “overactive bladder syndrome” – This might be a feeling of having to urinate all the time or needing to urinate immediately. Some people also leak urine if they don’t get to the bathroom in time. This can happen after surgery, or get worse for people who had it before surgery.
  •  Pain during sex
  •  Pain in the groin – This is the area where the thigh and body meet.

 

Are there options besides surgery for stress urinary incontinence?

Yes. There are other options. These include exercises or a pessary (a device that you wear in the vagina every day to support the urethra). Most women try these other options first. Then, they have surgery if other treatments do not work.

It’s important to remember that the results of surgery to treat stress urinary incontinence are different for every woman. You are the only one who can decide for sure whether surgery is the best treatment for you. If you aren’t sure, you might want to try other treatments while you think about surgery. Talk with your doctor about how much surgery might help you.

 

 

 

 

 

 

 

 

Dr. Pinky Ronen, M.D.

950 Threadneedle, Suite 282

Houston, Texas 77079

713-464-4444 phone

713-465-9718 fax

 

 

 

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