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Urinary incontinence - loss of bladder control - Treatment.
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Urinary incontinence - loss of bladder control

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Treatment

Treatment for urinary incontinence depends on the type of incontinence, the severity of your problem and the underlying cause. Your doctor will recommend the approaches that are best suited to your condition. Often a combination of treatments is used. Most people treated for urinary incontinence see a dramatic improvement in their symptoms.

Treatment options for urinary incontinence fall into four broad categories — behavioral techniques, medications, devices and surgery.

Behavioral techniques
Behavioral techniques and lifestyle changes work well for certain types of urinary incontinence. They may be the only treatment you need.

  • Bladder training. Your doctor may recommend bladder training — alone or in combination with other therapies — to control urge and other types of incontinence. Bladder training involves learning to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. Then try upping the waiting period to 20 minutes. The goal is to lengthen the time between trips to the toilet until you're urinating every two to four hours.

Bladder training may also involve double voiding — urinating, then waiting a few minutes and trying again. This exercise can help you learn to empty your bladder more completely to avoid incontinence. In addition, bladder training may involve learning to control urges to urinate. When you feel the urge to urinate, you're instructed to relax — breathe slowly and deeply — or to distract yourself with an activity.

Nighttime bladder training may be reinforced with devices such as moisture alarms, which wake you up when you begin to urinate. They are particularly helpful for children who wet the bed at night. The devices consist of a fluid-sensitive pad worn in pajamas, a wire connecting to a control, and an alarm that sounds or vibrates when moisture is first detected. Moisture alarms help children learn to awaken when their bladder is full, in time to go to the bathroom.

  • Scheduled toilet trips. This means timed urination — going to the bathroom according to the clock rather than waiting for the need to go. Following this technique, you go to the toilet on a routine, planned basis, usually every two to four hours.

  • Pelvic floor muscle exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles — the muscles that help control urination. Your doctor may recommend that you do these exercises three or four times a day to treat your incontinence. They are especially effective for stress incontinence, but may also help urge incontinence.

To do pelvic floor muscle exercises (Kegels), imagine that you're trying to stop from passing gas. Squeeze the muscles you would use and hold for a count of three. Relax, count to three again, then repeat. You can do these exercises almost anywhere — while you're driving, watching television or sitting at your desk at work.

With Kegels, it can be difficult to know whether you're contracting the right muscles. In general, if you sense a pulling feeling when you squeeze, you're using the right muscles. Men may feel their penis pull in slightly toward their body. To double-check that you're contracting the right muscles, try the exercises in front of a mirror. Your abdominal, buttock or leg muscles shouldn't tighten if you're isolating the muscles of the pelvic floor. You can also test yourself by trying to stop your urine midstream, although most people with incontinence can't stop their urine midstream, so don't lose hope if you can't. Another way to be sure you're doing Kegels correctly is a simple finger test. Place a finger in your anus or vagina (for women). Then squeeze around your finger. The muscles you contract are your pelvic floor muscles.

If you're still not sure whether you're contracting the right muscles, you can ask your doctor for help. Your doctor can refer you to a physical therapist for biofeedback techniques that will help you identify and contract the right muscles.

After several months of doing pelvic floor muscle exercises correctly, you should notice improvement in your urinary control. To further strengthen their urinary and pelvic floor muscles, women can use "vaginal weights." These are tampon-shaped cones of increasing weight that women can insert into their vaginas and try to hold in place.

  • Electrical stimulation. In this procedure, electrodes are temporarily inserted into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but it takes several months and multiple treatments to work.

  • Fluid and diet management. In some cases, you can simply modify your daily habits to regain control of your bladder. You may need to cut back on or avoid alcohol or caffeine, if either cause you incontinence. If acidic foods irritate your bladder, cutting back on such triggers may rid you of your problem. For some people, reducing liquid consumption before bedtime is all that's needed. Losing weight also may eliminate the problem.

  • Other techniques. For stress incontinence, contracting your urinary muscles to hold urine in or crossing your legs at certain times — such as when you feel a sneeze coming — may help significantly.

Medications
Many times, urinary incontinence can be corrected with the help of medication. Drugs commonly used to treat incontinence include:

  • Anticholinergic (antispasmodic) drugs. These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Examples include tolterodine (Detrol), oxybutynin (Ditropan) and hyoscyamine (Levsin). These drugs can be very effective at controlling incontinence, but a side effect is dry mouth. To combat dry mouth, you may be tempted to drink more water. But that may not help your incontinence. Your doctor may recommend that you suck on a piece of candy or chew gum instead to produce more saliva.

  • Imipramine (Tofranil). This antidepressant may be used to treat incontinence. It causes the bladder muscle to relax, while causing the smooth muscles at the bladder neck to contract.

  • Pseudoephedrine. In the past, some doctors recommended medications that contain pseudoephedrine (Dimetapp, Sudafed) to treat mild to moderate stress incontinence. These cold medications slightly tighten the urinary sphincter. However, these products can cause dangerous, rapid heartbeats, so they're no longer used for incontinence.

  • Hormone replacement therapy. After menopause, a woman's body produces less of the hormone estrogen. This drop in estrogen can contribute to changes in the skin lining the urethra and vagina, which can contribute to the development of incontinence in some women. Applying estrogen in the form of a vaginal cream, ring or patch may help relieve some of the symptoms of incontinence in these women. Oral estrogen may not have the same benefits as topical creams and ointments. Taking HRT as a combination therapy — estrogen plus progestin — can result in serious side effects and health risks. Work with your doctor to evaluate the options and decide what's best for you.

In children, nighttime incontinence may be due to a shortage of the nighttime production of a hormone called antidiuretic hormone (ADH). This hormone slows the making of urine. The body normally produces more ADH at night, so the need to urinate is lower. If a child doesn't produce enough ADH at night, the making of urine doesn't slow down and the bladder overfills. If the child doesn't sense the bladder filling and awaken to urinate, he or she wets the bed. A synthetic version of ADH — known as desmopressin (DDAVP) —is available as a nasal spray or pill for children to use before bedtime.

  • Antibiotics. If your incontinence is due to a urinary tract infection or an inflamed prostate gland (prostatitis), your doctor can successfully treat the problem with antibiotics.

  • Others. Your doctor may prescribe drugs that actually relax your urinary sphincter or make your bladder contract more, depending on the underlying cause of your incontinence.

If you're a man with incontinence caused by an enlarged prostate gland, your doctor may prescribe medications or other therapies to treat your condition. The goal may be to relax muscles around your urethra so that you can urinate with more control or to shrink the size of your prostate.

Drugs can be effective at treating urinary incontinence. But they may have side effects. Ask your doctor about what to expect from a treatment.

If a medication you're taking — such as a sedative — is the cause of incontinence, your doctor may lower the dosage or change the medication to relieve that side effect.

Medical devices
Several medical devices are available to help treat incontinence. They're designed specifically for women and include:

  • Urethral inserts. These are small, tampon-like disposable devices or plugs that a woman inserts into her urethra — the tube where urine exits the body — to prevent urine from leaking out. Urethral inserts aren't for everyday use. They work best for women who have predictable incontinence during certain activities, such as while playing tennis. The device is inserted before the activity. Whenever the woman needs to urinate, she simply removes the device. Urethral inserts are available by prescription.

  • Pessary. Your doctor may prescribe a pessary — a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage. You need to regularly remove the device to clean it. You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.

Surgery
If other treatments aren't working, there are nearly 100 variations of surgical procedures used to fix problems that cause urinary incontinence. In men, surgery may be necessary to remove an enlarged prostate gland that's constricting the urethra. Surgical removal of a tumor in the bladder or a uterine fibroid also may eliminate incontinence.

If your bladder or uterus has slipped out of position, a surgeon can put the structure back in place with a variety of techniques. Rarely, surgery to treat urinary incontinence may involve enlarging the bladder or correcting a birth defect. Or surgery may be needed to bolster weakened urinary sphincter muscles.

Some of the more common procedures include:

  • Artificial urinary sphincter. This small device is particularly helpful for men who have weakened urinary sphincters from treatment of prostate cancer or an enlarged prostate gland, and it's rarely used for women with stress incontinence. Shaped like a doughnut, the device is implanted around the neck of your bladder. The fluid-filled ring keeps your urinary sphincter shut tight until you're ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to be released. This surgery can cure or greatly improve incontinence in more than 70 percent to 80 percent of men with incontinence. Complications include malfunction of the device — which means the surgery will need to be repeated — and infection, but infection is uncommon.

  • Bulking material injections. Some women with stress incontinence benefit from urethral injections of bulking agents. This procedure involves injecting bulking materials — usually animal or human collagen — into the tissue surrounding the urethra or the skin next to the urinary sphincter. The injection tightens the seal of the sphincter by bulking up the surrounding tissue. The procedure is done with minimal anesthesia and typically takes about two to three minutes. It usually needs to be repeated every six to 18 months, because the bulking agents that are currently available don't remain effective over time. There is a risk of rejection or infection, and the procedure is generally not as effective as open surgery.

  • Sacral nerve stimulator. This small device acts on nerves that control bladder and pelvic floor contractions. The device, which resembles a pacemaker, is implanted under the skin in your abdomen. A wire from the device is connected to a sacral nerve — an important nerve in bladder control that runs from your lower spinal cord to your bladder. Through the wire, the device emits electrical pulses that stimulate the nerve and help control the bladder. The pulse doesn't cause pain and may improve or cure 50 percent to 75 percent of people with tough-to-treat urge incontinence or urinary retention leading to overflow incontinence. Possible complications include infection, but the device can be removed.

  • Sling procedure. The most popular surgery for women with stress incontinence is the sling procedure. During this procedure, a surgeon removes a strip of abdominal tissue and places it under the urethra. Or the surgeon may use a strip of synthetic material or a strip of tissue from a donor or cadaver. These strips act like a hammock, compressing the urethra to prevent leaks that occur with the activities of daily living.

The success of your treatment depends on the right diagnosis. Talk to your doctor about the specifics and possible complications of any treatment. Ask questions and express concerns to help find out which treatment is right for you.

Absorbent pads and catheters
If medical treatments can't completely eliminate your incontinence — or you need help until a treatment starts to take effect — you can try products that help ease the discomfort and inconvenience of leaking urine.

Various absorbent pads are available to help you manage urine loss. Most products are no more bulky than normal underwear and can be worn easily under everyday clothing. Men who have problems with dribbles of urine can use a drip collector — a small pocket of absorbent padding that's worn over the penis and held in place by closefitting underwear. Men and women can wear panty liners or pads in their underwear to collect urine. Adult diapers are available in both disposable and reusable forms and come in a variety of sizes. Some people find wearing plastic underwear over their regular underwear helps keep them dry. Others opt for washable underwear and briefs with waterproof panels. Incontinence products can be purchased at drugstores, supermarkets and medical supply stores.

If you're incontinent because your bladder doesn't empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder. This may give you more control, especially if you suffer from overflow incontinence.

In some cases people have to keep a catheter in constantly. The catheter is connected to an external bag to hold urine. As needed, the bag is emptied.

Prevention

Incontinence may or may not be something you can prevent. Oftentimes the cause of incontinence is out of your control.

However, you may be able to decrease your risk of urinary incontinence by taking good care of yourself and keeping or getting your weight under control. Because pregnancy and childbirth can weaken the urinary sphincter and pelvic floor muscles, doctors may advise pregnant women to do Kegel exercises during pregnancy as a preventive step.

Avoiding or limiting certain foods and drinks may help prevent incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or forgoing caffeine may be all that you need to do.

Including more fiber in your diet or taking fiber supplements can help prevent constipation, which can be a cause of incontinence. Your doctor may recommend that you drink more or less water as a preventive measure, depending on your bladder problem.

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