Urinary Incontinence (Part Three)

Pelvic Floor Muscle Exercises

Your doctor recommends performing frequent exercises that help strengthen the muscles involved in controlling urination. These exercises, also known as Kegel exercises, are particularly effective in stress incontinence, but can also help with urge incontinence.

To do these pelvic floor muscle exercises, imagine you are trying to stop the flow of urine:

• Tighten the muscles you would use to stop urinating for five seconds, then relax them for another five seconds. (if this is too difficult, start by holding for two seconds and releasing for three seconds)
• Continue holding it tighter each time up to ten seconds.
• The goal is to perform this exercise three times in a row, repeating ten times a day.

Electrical Stimulation

Electrodes that are temporarily placed in the rectum or vagina are used to stimulate and strengthen the pelvic floor muscles. Mild electrical stimulations can be effective for stress incontinence and urge incontinence, but may need to be repeated many times over several months.

Medications

• Anticholinergics. These can calm an overactive bladder and may help with urge incontinence. There are several medications such as oxybutynin (Ditropan), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare), and trospium (Sanctura).
• Mirabegron (Myrbetriq). Used in the treatment of urge incontinence (from strong bladder stimulations). It relaxes the bladder muscles and increases the amount of urine that the bladder can hold. Also, it increases the amount of urine that is expelled at the same time interval, making it possible to completely empty the bladder.
• Alpha-blockers. These are used in men with urge incontinence (from bladder stimulations) or incontinence due to overflow. They work by relaxing the muscles of the bladder neck and the prostate muscles, facilitating bladder emptying. Some of these medications are: tamsulosin (Omnic), alfuzosin (Xatral), silodosin (Rapaflo), terazosin (Hytrin), and doxazosin (Cardura).
• Local Estrogens. This is used in women. Local estrogen which can be in the form of cream, ring, or tablet is placed in the vagina to help tone and rejuvenate the tissues of the urethra and vaginal area. This may alleviate some of the symptoms of incontinence.

Medical Devices

Devices designed for the treatment of women with incontinence:

• Urethral Tampon, is a small device like a tampon, single-use that is temporarily inserted into the urethra before a particular physical activity, such as tennis which may cause incontinence. It serves as a stopper to prevent wetting and is removed before urination.
• Ring that is inserted into the vagina and left all day. This device holds up the bladder as it lies close to the vagina, preventing urine spillage. Those with incontinence due to bladder or uterine prolapse may benefit from it.

Interventional Therapies

These include:

• Injection of bulking materials. It consists of injecting a synthetic material into the tissues surrounding the urethra. The bulking material presses the urethra and reduces urine leakage. This procedure is much less effective than more invasive methods such as those for stress incontinence and needs to be repeated regularly.
• Botulinum toxin type A (Botox). Botox injections into the bladder muscle benefit patients who have an overactive bladder. Generally, Botox is recommended only if the first method of treatment has not been successful.
• Nerve Stimulators. A device similar to a pacemaker (used in cardiology) is implanted under the skin to send harmless electrical impulses to the nerves controlling bladder activity (sacral nerves). Sacral nerve stimulation can control urge incontinence if other methods have not worked. The device can be implanted under the skin in the buttock area and directly connected to the sacral nerves, or it can send impulses to these nerves through the nerve of the ankle joint.

Surgical Treatment

If other methods do not yield results, then various surgical procedures can be used.

• Sling procedures. This consists of using a loop made from the patient's own tissues or synthetic materials placed around the urethra or bladder neck to keep the urethra closed, especially when the patient laughs or sneezes. This procedure is used in the treatment of stress incontinence.
• Lifting the neck of the urinary bladder. This is an operation that consists of lifting the neck of the bladder through abdominal intervention.
• Prolapse (slippage) surgery. In women with mixed incontinence and pelvic organ prolapse, surgery may involve combining the sling procedure with prolapse surgery.
• Artificial urinary sphincter. The sphincter is a muscular ring around the neck of the bladder which opens the channel before urination, and closes it after urination. The artificial sphincter consists of a small artificial ring filled with water, placed around the neck of the bladder keeping the channel closed until the moment of urination. To urinate, a valve placed under the skin is pressed which empties the upper ring allowing urine to flow. This device is mainly used in men with incontinence as a result of treatment for prostate cancer or an enlarged prostate.

Absorbent Materials (Absorbers) and Catheters

If various treatments do not completely eliminate incontinence, assistive materials may be used:

• Protective Wear. These are special materials that absorb urine and are placed under underwear.
• Catheters. If incontinence is the result of not completely emptying the bladder, it is recommended to insert the catheter several times a day for its emptying by the patient themselves.

Home Care

Problems arising from wetting with urine require extra care to prevent skin irritation:

• To use wipes for cleaning
• To let the skin air dry
• To avoid frequent body washing and showers as these damage the bladder's natural protection against infections
• To use cream to protect the skin from urine