Treating female incontinence
Urinary incontinence treatments depend on the type, severity, and the underlying cause of the problem. Treatment options range from conservative approaches, such as behavioral techniques and physical therapy to more aggressive options, like surgery. In most cases, the least invasive treatments will be suggested first, so behavioral techniques and physical therapy will be the starting point and then other options if these techniques fail. Often a combination of treatments is used to treat bladder control problems. Any treatment for female urinary incontinence should a woman’s person lifestyle and goals, focusing on reducing the amount of incontinence episodes.
The goal of behavioural therapy is to help women regain control of their bladder. A doctor might spot a pattern of urination, for example, and may suggest using the bathroom at regular timed intervals, a habit called timed voiding. As a woman gains bladder control, she can extend the time between scheduled trips to the bathroom. Specific methods used during behavioural therapy include the following:
Biofeedback - Biofeedback employs measuring devices that help one become aware of the body’s functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, a woman can gain control over these muscles. Biofeedback can also be used as a supplement to pelvic muscle exercises and electrical stimulation to alleviate stress and urge incontinence.
Kegel exercises - These exercises strengthen the muscles that help hold in urine. Performing Kegel exercises can strengthen pelvic muscles as well. This can help prevent stress leakage.
Toileting assistance - This type of bladder control treatment involves routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder regularly and prevent leaking.
Although many women can improve urinary continence through treatment, some will never live completely dry. Medications can cause incontinent episodes or cognitive / physical impairments may keep them from being able to perform pelvic muscle exercises, or retrain their bladders. Protective measures and lifestyle changes can help mitigate the effects of urinary leakage during these cases. For example, women can manage incontinence using a throwaway patch, a tampon-like plug or similar solutions. Other self-care methods that can be employed include:
Disposable absorbent garments - Used to keep people dry.
Improved access to toilets - Using equipment can make toileting easier, such as canes, walkers, wheelchairs, and devices that raise the toilet seating level.
Managing fluids and diet - Doctors suggest that women eliminate caffeine from the diet (for those with urge incontinence) and consume adequate fiber. Eliminating certain foods and liquids such as alcohol, tea, coffee and other caffeinated products can help reduce incontinence.
Prompted voiding - Check for dryness and encourage use of the toilet.
Scheduled toileting - Toilet visits every 2 to 4 hours based on observed habits.
Weight loss - Losing extra pounds can relieve pressure on the bladder.
Incontinence need not be some embarrassing affliction that keeps a women isolated, living a less-than-full life. Many options exist to help those with these types of urinary problems, including the following medical procedures:
Catheterization - Catheters are used to empty the due to overflow incontinence, poor muscle tone, past surgery, or spinal cord injury. A catheter is a tube that is inserted through the urethra into the bladder to drain urine. A catheter can be used sporadically, or on a constant basis where the tube connects to a bag attached to the leg. Long-term use of a catheter increases risk of possible urinary tract infections.
Injections for stress incontinence - Bulking agents such as collagen and carbon spheres are available for injection near the urinary sphincter. The doctor injects tissues around the bladder neck and urethra to make those tissues thicker and close the bladder opening to reduce stress incontinence.
Neuromodulation - Neuromodulation is used when urge incontinence is unresponsive to behavioral treatments or drugs. Neuromodulation involves stimulation of nerves to the bladder leaving the spine. Although neuromodulation can be effective, it isn’t for everyone. The therapy is costly, utilizing surgery with possible surgical revisions and replacement.
Pessary insertion - Vaginal devices may be necessary for treating stress incontinence, due to weak pelvic muscles that hold the bladder in place and also hold urine inside. A pessary is a stiff ring that a doctor inserts into the vagina, where it presses against the vaginal wall and urethra. This pressure helps reposition the urethra, resulting in less stress leakage.
Medications prescribed by a physician can help reduce certain types of leakage. For women diagnosed with an overactive bladder, medicine may be prescribed to block the nerve signals that cause frequent urination and urgency. A class of drugs called anticholinergics can help relax bladder muscles and prevent spasms. Some medicines can affect the nerves and muscles of the urinary tract in varying ways. Pills to treat swelling (edema) or high blood pressure can increase urine output and contribute to bladder control problems. Taking an alternative to a medicine already in use may solve the problem without adding another prescription.
Surgeons have described more than 200 procedures for stress incontinence alone, so no single surgery stands out as a best way to treat urinary incontinence. In some women, the bladder moves out of its normal position, especially following childbirth. So surgeons have developed different techniques for correcting this shift. For women experiencing pelvic prolapse, however, a surgeon may recommend an anti-incontinence procedure with a prolapse repair and possibly a hysterectomy. In general, the three main types of surgery used to treat urinary incontinence in women are retropubic suspension and two types of sling procedures.
Retropubic suspension - Retropubic suspension employs surgical threads (sutures) to support the bladder neck and is often performed at the same time as other abdominal procedures such as a hysterectomy.
Sling procedures - These are performed through a vaginal incision. The traditional sling procedure uses a strip of your own tissue called fascia to cradle the bladder neck and to provide the proper amount of support to the urethra. However, slings can consist of natural tissue or man-made material.
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