For the millions of women affected with any form of incontinence, or urinary leakage, there are excellent treatments to relieve this uncomfortable and embarrassing condition. While many women manage leakage by wearing pads, and limit the intake of liquids that may worsen the condition (such as coffee, tea, and alcohol), seeing a urologist about treatments can create life without incontinence.
Urinary incontinence (UI) must be properly diagnosed, since there are several different common types: stress incontinence, urge incontinence, overactive bladder, and mixed incontinence. Treatment should be tailored to the exact nature of the problem. However, some treatments will be effective for more than one type.
In a previous article on this site, it was mentioned that an early diagnostic step is for the patient to keep a record or log of bathroom use and leakage. The doctor will analyze the daily record and discuss it with the patient. In many instances, the patient’s urinary habits can be adjusted to use the bathroom at very specific times throughout the day. This is called “timed voiding” and is a simple way to take control of urination. The intervals between bathroom use can be gradually lengthened, in effect “retraining” the bladder.
Another behavioral approach is to exercise the muscles of the pelvic floor, called Kegel exercises.
To locate these muscles, try stopping the flow of urine when using the toilet.
To locate these muscles, try stopping the flow of urine when using the toilet. (They are the same muscles that people tighten when avoiding passing gas in public.) If weakened muscles, especially due to childbirth, are the source of the problem, your doctor will discuss simple, correct exercises you can do a few minutes each day without anyone knowing you are doing them.
For those with difficulty locating the correct muscles, perhaps due to nerve damage, special training with biofeedback or painless electrical stimulation is available.
Medical Treatments for Stress Incontinence: Device, Injections, Surgery
If the source of the leakage is stress incontinence, a simple device called a pessary can be inserted into the vagina. It is a stiff ring which, when properly positioned, creates pressure on the urethra (tube that carries urine out of the body) through the vaginal wall. It leads to less leakage by repositioning the vagina. The doctor will go over precautions for using a pessary, and schedule regular check-ups.
Certain substances that can reshape bladder and urethra structures by adding bulk (think of collagen injections to plump lips) can be painlessly injected under local anesthesia. The doctor injects the bulking agents into areas around the bladder neck and urethra to thicken the tissues and reduce the bladder opening. Since the body tends to slowly eliminate these agents over time, repeat injections may be warranted.
If the incontinence is the result of the bladder having slipped out of its normal position due to childbirth or other reasons, there are different surgical approaches to restructuring the bladder back to its normal place.
- Retropubic suspension places surgical threads (sutures) in strategic locations attached to strong pelvic ligaments to support the bladder neck. Access is usually gained through an incision below the navel. It can also be done in conjunction with a hysterectomy.
- Sling and support procedures are performed through a vaginal incision. There are different types of approaches, and different types of materials that safely cradle and support the bladder neck.
Medical Treatments for Urge Incontinence and Overactive Bladder
If the nature of the urinary incontinence is due to bladder spasms caused by abnormal nerve signals, there are special medicines to block these signals. Your doctor will want to know any other medications you take, since some drugs that control swelling or high blood pressure may have the side effect of bladder control problems. Sometimes simply switching from one drug to another alleviates the problem. As with stress incontinence, biofeedback may be helpful in locating muscles that can be strengthened and retrained.
If behavioral or medical treatments do not correct urge incontinence, a patient can be evaluated for a procedure called neuromodulation. This involves surgically implanting a device that stimulates the nerves that go from the spine to the bladder, and is often done at the time of other abdominal surgery. If other therapies have not been effective, your doctor may discuss conducting tests to determine if you are a candidate for this technique.
Talk To Your Urologist
Sadly, many women suffer silently with incontinence out of embarrassment and shame. They may endure wearing absorbent undergarments, or diapers, without exploring a solution to the problem of UI. This can lead to low self-esteem, restricted socializing and activity, and can also result in skin irritation and sores. Physicians such as Dr. Alarcon offer new hope. If your quality of life is diminished due to UI, talk to your urologist to find the treatment that can change your life for the better.