Treatment for incontinence
Incontinence is a common treatable condition. Just as there are many different causes of urinary incontinence, there are also many treatments methods. The choice of treatment depends on the type of bladder control problem diagnosed, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.
The goals of treating bladder control problems are to:
Alternative medicine can't cure urinary incontinence. But some people may experience relief from the following methods. However, evidence is very limited. Further research is needed before these methods can be recommended for urinary incontinence.
Acupuncture - During an acupuncture session, a practitioner inserts small needles into precise points on the body to remove energy blocks that might be causing incontinence.
Hypnotherapy - Hypnosis is typically performed by a licensed therapist who leads you through relaxation exercises and aims to improve bladder function and control.
Herbs - Aloe vera extract, crataeva (crataeva nurvala) and/or horsetail (equisetum) may help strengthen the muscles of the urinary system and relieve symptoms of incontinence.
Behavioral therapies can help rehabilitate the pelvic floor. Behavioral therapy builds the strength and function of the muscles that support the bladder, urethra and other organs contained within the pelvic region. Behavioral treatments are simple and self-directed, although it may help to work with a physical therapist that has special training in pelvic muscle exercises.
Biofeedback — Biofeedback for urinary incontinence teaches how to control and strengthen the pelvic floor muscles that play an important role in bladder control. Specifically, biofeedback therapy uses computer graphs and audible tones to show you bladder control muscles as you contract or relax them. Biofeedback therapists can then individualize an exercise program to help you learn to control and strengthen the pelvic floor area.
Bladder training — Bladder training/retraining includes urinating at scheduled times in the day to help regain control of urinary muscles. During this therapy, you try to increase the interval between each time you urinate and to increase the amount of fluids your bladder can hold. This training can help diminish the sense of urgency and leakage.
Pelvic muscle exercises — Pelvic muscle exercises, also known as Kegels, can help improve incontinence and prevent the condition from worsening. Exercises strengthen and tone the muscles that support the pelvic organs. To achieve the best results, doctors recommend regular exercise and correct technique.
Urge suppression — Bladder irritability increases when you lose control of the bladder. Urge suppression aims to control the sudden urge to urinate so that going to the bathroom is not an emergency.
Botulinum toxin type A - Botulinum toxin type A (botox) injections into the bladder muscle may benefit people who are diagnosed with an overactive bladder.
Catheter - Your doctor may recommend that you learn to insert a soft tube (catheter) into the urethra several times a day to drain the bladder. This should give you more control of leakage.
Radiofrequency therapy - This non-surgical procedure uses radiofrequency energy to heat tissue in the lower urinary tract. Once the tissue heals, it is usually firmer, which may reduce urinary leaks.
Sacral nerve stimulator – Doctors implant a device under the skin in the buttock which is connected to a sacral nerve — an important nerve related to bladder control. Through the wire, the device emits painless electrical pulses that stimulate the nerve and help control the bladder.
Maintaining good overall health can help curb symptoms of an overactive bladder. However, you may need help until a treatment starts to take effect. If medical treatments can't completely eliminate incontinence you can try some of the following suggestions to east the discomfort and inconvenience of leaking urine. For example, absorbent pads (adult diapers, panty liners or pads) can help manage urine loss. Most products are no more bulky than normal underwear, and you can wear them easily under everyday clothing. Men can use a drip collector which is a small pocket of absorbent padding worn over the penis. Other lifestyle changes that can help with bladder problems include:
Diet - Avoid or limit certain foods and drinks (such as caffeinated beverages) to help prevent or limit urinary incontinence. Eat more fiber to help prevent constipation, a risk factor for urinary incontinence.
Exercise - Physical activity reduces your risk of developing incontinence.
Less caffeine - Cut back on caffeine drinks.
Less fluids at night - If it bothers you to get up at night to urinate, cut down on fluids before bed (not during the day).
Lose weight - Maintain a healthy weight. If you're overweight, reaching a healthy weight may help.
Practice Kegel exercises - Doctors may advise pregnant women to strengthen pelvic floor exercises to help prevent incontinence.
Quit smoking - Don't smoke. Get help with quitting if you do smoke.
Toilet access - At night, clear a path from your bed to the bathroom. Or place a portable toilet by the bed.
Urinate fully - When you go to the bathroom, urinate as much as you can. Then relax for a few seconds and try again. Practice this each time you urinate.
Medications do not cure incontinence but can help reduce or eliminate problems of bladder control. Doctors usually prescribe medicine for urinary incontinence only when bladder training and exercises don't work first. Medications can help relax the bladder and provide relief from symptoms.
Anticholinergic /Antimuscarinics - Anticholinergic and antimuscarinics are classes of drugs that can block the chemicals that act on the bladder nerves to decrease bladder contractions.
Hormone replacement therapy - Vaginal estrogen (creams, vaginal rings or vaginal pellets) have helped reduce recurrent urinary tract infections in postmenopausal women. Estrogen replacement therapy, however, has not been shown to be an effective treatment for female urinary incontinence.
Oxybutynin chloride - Oxybutynin chloride is an extended-release tablet taken once a day and is effective for treating overactive bladder.
Several medical devices are available to help treat incontinence. These devices are designed specifically for women who experience bladder control problems and include:
Bulking material injections - Bulking agents (collagen, carbon-coated zirconium beads or coaptite) can be injected into tissue surrounding the urethra to help keep the urethra closed and reduce urine leakage.
Urethral inserts – Urethral inserts are small disposable devices or plugs that a woman inserts into her urethra to prevent urine from leaking out.
Pessary – A pessary is a stiff ring that is inserted into the vagina to help hold up the bladder and prevent urine leakage. Doctor recommend pessaries for women diagnosed with incontinence due to a dropped (prolapsed) bladder or uterus.
If other treatments aren't working, several surgical procedures have been developed to fix problems that cause urinary incontinence. Some of the more common procedures include:
Artificial urinary sphincter – During this procedure (for men only), a small device is is implanted around the neck of the bladder. The fluid-filled ring keeps the urinary sphincter shut tight until ready to urinate. To urinate, you press a valve implanted under the skin that causes the ring to deflate and allows urine from your bladder to flow.
Bladder neck suspension – A bladder neck suspension provides support to the urethra and bladder neck, an area of thickened muscle where the bladder connects to the urethra. This procedure involves an abdominal incision and is completed under general or spinal anesthesia.
Sling procedures - A sling procedure uses strips of body tissue, synthetic material or mesh to create a pelvic sling or hammock around the bladder neck and urethra to keep the urethra closed. Types of slings include tension-free slings, adjustable slings and conventional slings.
If you're embarrassed about a bladder control problem, you may try to cope on your own. You might try absorbent pads, carrying extra clothes, or even staying at home to avoid episodes. You may even cut back on drinking liquids and risk dehydration. But there are better ways to manage urinary incontinence, and new treatments for incontinence are continually being discovered. That's why it's important to see your doctor and ask about treatment options.
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