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What is incontinence?
Incontinence is the inability to control the passage of urine or stool.
Current figures indicate that 20 million Americans suffer with involuntary loss
of bladder control (urinary incontinence) and that 10 percent of these people also have
problems with bowel control (fecal incontinence).
Often, embarrassment and the stigma associated with incontinence prevent the
person from seeking treatment, even when incontinence threatens his or her
quality-of-life and that of his or her family.
Urinary and fecal incontinence can be cured or significantly improved once
the underlying cause has been detected. However, it's important to recognize
that incontinence is a symptom and not a disease. Its cause may be quite complex
and involve many factors. Your physician should complete an in-depth evaluation
before beginning treatment.
What can I do to address this problem?
Getting help means taking the first step. See your doctor. Diagnostic
tests for incontinence can be completed in the outpatient setting and are not
painful. Once these tests have confirmed the cause of your incontinence, your
physician can make specific recommendations for treatment, many of which do not
require surgery. No matter how serious the problem seems, incontinence is a
condition that can be significantly helped and, in most cases, cured.
How can incontinence be treated?
Urinary incontinence can be caused by many different factors. Your physician
will suggest a treatment plan after considering these factors and your specific
symptoms. Common treatments for urge and stress incontinence, two common types
of incontinence, are described below.
Urge incontinence
Urge incontinence is an urgent desire to void, which is followed by an
involuntary loss of urine. This condition can be caused by an
"overactive" bladder. Normally, strong muscles (sphincters) control
the flow of urine from the bladder. The muscle of an "overactive"
bladder spasms (contracts) with enough force to override the sphincter muscles
of the urethra and allow urine to pass out of the bladder.
- Medications for "overactive bladder"
Medications can work very well to return normal function to the bladder. The
type of medication used should also be chosen for your specific needs. Your
physician may prescribe a low dose and then gradually increase the dose. In this
way, he or she can evaluate the how well the drug is working and reduce your
risk of experiencing side effects. Your physician should discuss with you the
risks and benefits of using medications. Common medications used include:
Anticholinergic medications (These medications
control muscle spasms in the bladder):
- Oxybutynin (Ditropan), Oxybutynin XL (Ditropan XL), Oxybutynin
TDDS (Oxytrol)
- Propantheline (Pro-Banthine)
- Dicyclomine (Antispas, Bentyl, Di-Spaz, Dibent, Or-Tyl, Spasmoject)
- Tolterodine (Detrol)
Antidepressant medication
- Imipramine (Norfranil, Tipramine, Trofranil)
- Self-help techniques
- Empty your bladder regularly, especially before physical
activity.
- Avoid drinking caffeine or a lot of fluid before activities.
- Avoid lifting heavy objects.
- Practice Kegel exercises (explained later in this document).
- Practice timed voidings. (Go to the bathroom on a regular
schedule rather than waiting for the urge.)
- Aids used with self-help techniques
- Perineometer--This device is used to measure
the force of the sphincter muscles.
- Vaginal cones (for women)--The woman inserts a
tampon-shaped cone into the vagina and holds it in place by contracting the
pelvic muscles. As the muscles get stronger, the weight of the cone is
increased.
- Electrical stimulation--Mild electrical
impulses are used to stimulate contractions of the pelvic floor muscles.
Devices for electrical stimulation can be implanted near the spine or
activated by the urethra, vagina, or rectum (non-implanted devices).
Electrical stimulation can be used for incontinence that does or does not
involve neurological problems.
- Biofeedback--In biofeedback, devices are used
to help you see the strength of your contractions. Biofeedback can help you
learn how to perform Kegel exercises.
- Surgery
Your physician may recommend surgery if other treatments fail to improve
your symptoms. Surgical procedures for urge incontinence can be used to:
- Increase the storage capacity of the bladder (hydro-distention)
- Limit nerve impulses to the control muscles (denervation)
- Divert the flow of urine
- Modulate the nerve to bladder/penis (neuromodulation)
Stress incontinence
Stress incontinence occurs when an activity, such as a cough or sneeze,
increases abdominal pressure on the bladder. Typically, a small amount of urine
leaks from the urethra. This problem can result from a number of factors,
including weak muscles of the pelvic floor, a weak sphincter muscle at the neck
of the bladder, or a problem with the way the sphincter muscle opens and closes.
Women who have given birth are more likely to have stress incontinence.
- Treatments for stress incontinence
Self-help techniques and aids, as described above, can be used to treat mild
stress incontinence.
Bulking agents
Bulking agents are substances that are injected into the lining of the
urethra. They increase the size of the lining of the urethra, which creates
resistance against the flow of urine. Collagen is one bulking agent commonly
used.
Surgery
When these methods fail, surgery may be an option. Surgery is now minimally
invasive and performed on an outpatient basis in most cases. Surgery can
be used to:
- Increase resistance in the urethra
- Implant an artificial sphincter
- Tighten the pelvic floor muscles
- Change pressure within the urethra using an implant device
Kegel exercises
Kegel exercises, also called pelvic floor exercises, help strengthen the
muscles that support the bladder, uterus, and bowels. By strengthening these
muscles, you can reduce or prevent problems such as leaking urine.
How to do Kegel exercises
Imagine you are trying to stop the flow of urine or trying not to pass gas.
When you do this, you are contracting the muscles of the pelvic floor and are
practicing Kegel exercises. While doing Kegel exercises, try not to move your
leg, buttock or abdominal muscles. In fact, no one should be able to tell that
you are doing Kegel exercises.
How often should I do Kegel exercises?
Kegel exercises should be done every day. We recommend doing five sets of
Kegel exercises a day. Each time you contract the muscles of the pelvic floor,
hold for a slow count of five and then relax. Repeat this ten times for one set
of Kegels.
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