Incontinence Treatment

  • Treatment

    If you have a complete blockage of urine, seek emergency room help right away. Blockage is a sign that something is obstructing your urine output, and may indicate a serious disease. It is important to seek medical help immediately. Prolonged retention of urine may damage the bladder, leading to further urinary problems. A doctor can drain the bladder with a catheter and determine the cause of the blockage.

    Go to the bathroom frequently, and make sure a bathroom is close by to prevent accidents. If you suffer from stress incontinence or urge incontinence, bladder training may help. Make it a point to urinate every hour for a week. Then see if you can extend the stretch to 2 hours, and then to 3 hours, and see how you do. This should help keep your bladder empty enough to sustain continence. As many as 15% of people with stress or urge incontinence stay dry this way. When you are out in public, be sure to locate and be near a bathroom so you are not caught short.

    Wear loose-fitting clothing to facilitate bathroom trips, and use protective undergarments as a safeguard. Be sure to wear clothes that are easy to slip in and out of so you don’t waste time when the urge to urinate strikes. In situations where you fear you may lose control, wear a disposable pad or another type of absorbent undergarment to protect your skin and keep you dry in an emergency.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Biofeedback can help teach you muscle control continence. If you lose control when you sneeze, cough, laugh, or do anything that increases abdominal pressure, and have a hard time sensing which muscles you use to hold urine in, you may benefit from biofeedback. During biofeedback, you will have electrodes placed on your bladder muscles, urinary sphincter, and abdominal muscles. An instructor will tell you to tense and relax the muscles, and auditory or visual feedback will let you know when you are doing it right. After training, you should be able to control your muscles automatically to prevent leakage in situations that increase abdominal pressure. Techniques learned through biofeedback may also help you hold your urine until you can reach a bathroom when you get a strong urge to go. More than half of people with stress incontinence and urge incontinence are cured or helped by biofeedback.

    Collagen injections can help the sphincter to close more tightly. If you experience episodes of stress incontinence and have good pelvic muscles and a functioning bladder, you may benefit from collagen injections to bulk up your sphincter. During this procedure, your physician will inject collagen into the tissue surrounding your urethra. It takes about a half an hour, and you should be able to go home afterwards..

    Researchers are also looking at Botox injections to treat incontinence. Transvaginal electrical stimulation helps some women remain dry. Some women with urge or stress incontinence benefit from electrical stimulation with a transvaginal probe. This device is used at home once or twice daily for 15 to 20 minutes per session. After 6 to 12 weeks 50% to 60% of women see an improvement in their symptoms. After symptoms improve, it is often possible to reduce treatments to three times per week. Women with pacemakers should avoid this treatment.

    When the outflow of urine is obstructed, a procedure to clear the blockage may be needed. Prostate cancer can obstruct the outflow of urine, and cause the bladder to become too full, and leak. Surgery to remove all or part of the prostate can resolve some cases of overflow incontinence.

    Surgery to repair or replace faulty structures can be helpful. The main surgical procedures include bladder neck suspensions, sling procedures, anterior repairs, and artificial urinary sphincter placement. Bladder neck suspensions and sling procedures can be very effective, curing up to 80% to 95% of carefully selected patients. Each surgery carries risks you should discuss with your surgeon.

    • Bladder neck suspension. This procedure corrects the position of the bladder and urethra by sewing or suturing the tissues adjacent to the bladder neck and urethra to a nearby supporting structure such as a bone or tough ligament, pelvic bone or nearby structure. It must be done in hospital under anesthesia, and recovery may take a while. Although the hospital stay is brief (one or two days), complete recovery to regular activities may take between 4 and 6 weeks.
    • Sling procedure. For this procedure, a piece of tissue or synthetic material is attached under the urethra and bladder neck, and is secured like a sling or hammock to the abdominal wall and pelvic bone to put the structures back into the proper position..
    • Anterior repair. This procedure relocates the connective tissue located under the bladder and neck to restore support of the bladder.
    • Artificial urinary sphincter placement. For this procedure, an artificial sphincter constructed out of silicone is implanted around the urethra, preventing urinary leakage.

    With the right treatment, your chances of solving your continence problem are very high. The percentage of patients cured varies by cause, treatment, and type of incontinence, but more than half of those suffering from stress or urge incontinence are helped by behavioral therapy or Kegel exercises alone. However, in order for such noninvasive treatments to work, patients must learn the correct way of practicing them and continue follow-up visits with a physician. Cure rates for surgery are very high, with as many as 95% of patients remaining dry 5 years after the operation.

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I'm Shereen A. Gharbia, PharmD. Welcome to PDR Health!

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