Selecting Medications For The Treatment Of Urinary Incontinence
BARRY D. WEISS, M.D., University of Arizona College of Medicine, Tucson, Arizona
Am Fam Physician. 2005 Jan 15 71:315-322.
In response to the growing population of older patients with incontinence, pharmaceutical companies are developing new drugs to treat the condition. Before prescribing medications for incontinence, however, physicians should determine the nature and cause of the patients incontinence. The evaluation should rule out reversible conditions, conditions requiring special evaluation, and overflow bladder. The best treatment for urge incontinence is behavior therapy in the form of pelvic floor muscle exercises. Medications, used as an adjunct to behavior therapy, can provide additional benefit. Many therapies are available for patients with stress incontinence, including pelvic floor muscle exercise, surgery, intravaginal support devices, pessaries, periurethral injections, magnetic chairs, and intraurethral inserts. No medication has been approved for the treatment of stress incontinence, although medications are under development.
Urinary incontinence is one of the most common chronic medical conditions seen in primary care practice. It is more prevalent than diabetes, Alzheimers disease, and many other conditions that receive considerably more attention. Incontinence is an expensive problem, generating more costs each year than coronary artery bypass surgery and renal dialysis combined.1,2
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What Is Bladder Leakage A Sign Of
Urinary incontinence is usually caused by problems with the muscles and nerves that help the bladder hold or pass urine. Certain health events unique to women, such as pregnancy, childbirth, and menopause, can cause problems with these muscles and nerves. Other causes of urinary incontinence include: Overweight.
Treatments For Stress Incontinence In Women
Urinary incontinence is the loss of bladder control, a condition that affects 13 million women in the United States. Stress incontinence, the most common type in women, is when leakage occurs during activities that put pressure on the bladder, such as coughing, sneezing, laughing, lifting, or running. These accidents happen when the muscles that contract to hold urine in are too weak to handle sudden pressure on the bladder during stressful activities.
Though stress incontinence affects people of all ages, races, and both sexes, it is twice as common in women as in men, and affects one in three women at some point in their lifetime. It is more common in women because pregnancy, childbirth, and menopause may weaken the pelvic floor muscles. The condition is especially common in older women post-menopause because the pelvic floor muscles tend to weaken with age, especially when hormone levels drop.
If stress incontinence is affecting your lifestyle, there are treatments that can lessen the problem or eliminate it entirely. There are many effective treatments, and surgery should be considered only as a last resort.
Pelvic floor muscle exercises, which you can perform yourself at no cost, is the treatment that has been shown to have the most consistent success to help women achieve bladder control. The fact that it is free is probably the reason it is not more widely used: nobody is advertising it because they cant make money.
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What Are The Symptoms Of Incontinence
The main symptom of incontinence is a leakage of urine. This could be a constant dripping of urine or an occasional experience of leakage. If you have incontinence, you might have large amounts or small amounts of leaked urine. You might experience leakage for a wide variety of reasons often depending on the type of incontinence you have.
You might leak urine when you:
- Have an urge to urinate, but cant make it to the toilet on time.
- Have to get up in the middle of night to urinate .
Is Urinary Incontinence Just Part Of Growing Older
No. But changes with age can reduce how much urine your bladder can hold. Aging can make your stream of urine weaker and can cause you to feel the urge to urinate more often. This doesnt mean youll have urinary incontinence just because youre aging. With treatment, it can be controlled or cured.
Learn More About Urinary Incontinence
There are 5 types of urinary incontinence, described below.
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Treatment Options For Stress Incontinence:
- Pelvic floor physical therapy This can improve up to 75% of symptoms.
- Pessary This device, inserted in the vagina, helps control leakage by providing support under the urethra and bladder.
- Urethra bulking This office-based procedure can help thicken the wall of your urethra so it more tightly seals to hold urine.
- Sling urethral surgery This outpatient surgery stops urine leakage via a sling that lifts and supports your urethra and lower bladder.
“If stress incontinence is severe, sling urethral surgery is typically about 95 percent successful and there’s very little down time as far as returning to everyday activities,” says Dr. Lindo.
Who Develops Urinary Incontinence
Stress incontinence is far more common among women than men. It can occur at any age. But the chances of developing stress incontinence increases with pregnancy and as you age.
According to the American Academy of Physicians , about 50 percent of women between the ages of 40 to 60, and nearly 75 percent of women over the age of 75, have some form of urinary incontinence . The actual figures may be even higher, since the condition is underreported and under diagnosed, according to the AAP. It estimates that about one-half of the women who experience UI do not report it to their doctors.
Certain factors can increase the risk of female urinary stress incontinence, or can aggravate symptoms if you already have it.
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Some General Lifestyle Measures Which May Help
- Your GP may refer you to the local continence adviser. Continence advisors can give advice on treatments, especially pelvic floor exercises. If incontinence remains a problem, they can also give lots of advice on how to cope. Examples include the supply of various appliances and aids such as incontinence pads, etc.
- Getting to the toilet. Make this as easy as possible. If you have difficulty getting about, consider special adaptations like a handrail or a raised seat in your toilet. Sometimes a commode in the bedroom makes life much easier.
- Obesity. Stress incontinence is more common in women who are obese. Weight loss is advised in those who are overweight or obese. It has been shown that losing a modest amount of weight can improve urinary incontinence in overweight and obese women. Even just 5-10% weight loss can help symptoms.
- Smoking can cause cough which can aggravate symptoms of incontinence. It would help not to smoke.
Surgical Treatments For Ui
Surgery to treat stress incontinence is available and works by giving more support to the urethra. There are also procedures available to treat urge incontinence.
Our doctors will help to decide if a procedure or surgery is the best option for you and will walk you through how it works as well as answer any questions you may have.
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How Is Urinary Incontinence Treated
Treatment options for urinary incontinence depend on the type of incontinence, the severity, and the underlying cause. A combination of medical treatments, exercises, and lifestyle modifications may be needed. Weight loss in the case of obese women has been shown to help some types of incontinence. The following are the treatment options.
- Fluid and diet management: Reducing or avoiding alcohol, caffeine, or acidic foods and decreasing fluid consumption.
- Bladder training: Training the bladder to delay urination after having the urge to urinate may help. The patient could start by trying to hold off going to the bathroom for 10 minutes every time there is an urge to urinate and gradually lengthening the time.
- Double voiding: First, the patient urinates after getting an urge. Then, the patient waits for a few minutes to urinate again.
- Pessary: Insertion of vaginal pessary may help reduce stress incontinence by supporting the bladder and vaginal wall. It can be inserted by the individual and may be available over the counter.
Pelvic floor muscle exercises:
Electrodes can be temporarily inserted into the rectum or vagina to stimulate and strengthen pelvic floor muscles.
Treatment Of Fecal Incontinence
The first step in treating your fecal incontinence is to see a doctor. Your doctor will talk to you about the causes of fecal incontinence and how they can be treated. Simple treatmentssuch as diet changes, medicines, bowel training, and exercises to strengthen your pelvic floor musclescan improve symptoms by about 60 percent.5 These treatments can stop fecal incontinence in 1 out of 5 people.5
Your doctor can recommend ways you can help manage and treat your fecal incontinence. Your doctor can also recommend ways to relieve anal discomfort and cope with your fecal incontinence.
You can play an active role in your treatment by talking openly and honestly with your doctor about your symptoms and how well your treatments are working.
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Strengthening The Pelvic Floor Muscles
It is important that you exercise the correct muscles. Your doctor may refer you to a continence advisor or physiotherapist for advice on the exercises. They may ask you to do a pelvic floor exercise while they examine you internally, to make sure you are doing them correctly. The sort of exercises are as follows:
Learning to exercise the correct muscles
- Sit in a chair with your knees slightly apart. Imagine you are trying to stop wind escaping from your back passage . You will have to squeeze the muscle just above the entrance to the anus. You should feel some movement in the muscle. Don’t move your buttocks or legs.
- Now imagine you are passing urine and are trying to stop the stream. You will find yourself using slightly different parts of the pelvic floor muscles to the first exercise . These are the ones to strengthen.
- If you are not sure that you are exercising the right muscles, put a couple of fingers into your vagina. You should feel a gentle squeeze when doing the exercise. Another way to check that you are doing the exercises correctly is to use a mirror. The area between your vagina and your anus will move away from the mirror when you squeeze.
- The first few times you try these exercises, you may find it easier to do them lying down.
What Is Bladder Training
Bladder training is a way of learning to manage urinary incontinence. It is generally used for stress incontinence, urge incontinence, or a combination of the 2 types .
Bladder training can help in the following ways:
- Lengthen the amount of time between bathroom trips
- Increase the amount of urine your bladder can hold
- Improve your control over the urge to urinate
Some bladder training techniques are explained in Bladder Training for Urinary Incontinence.
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Who Is Affected By Sui
Stress Urinary Incontinence is quite common, so its important to remember that youre not alone in managing this type of incontinence. According to the Urology Care Foundation, about 1 in 3 women suffer from SUI at some point in their life.
The likelihood of living with Stress Urinary Incontinence often increases with age. Currently, about 50% of women aged 65 or older suffer from the occasional urinary leak.
While men can also be affected by Stress Urinary Incontinence, it is usually more common for men to experience an overactive bladder . What is an overactive bladder you may ask? Well, an overactive bladder results in an uncontrollable urge to urinate which can sometimes lead to urine leakage. Men most affected by an SUI are oftentimes those who have had prostate cancer surgery, or pelvic nerve injury or damage.
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Be Ready And Prepared
Despite your best efforts, accidents may still happen from time to time. There are many products that can help you feel confident being out and participating in the world. Adult diapers are one option to stay dry in the event of an accident if you tend to leak large amounts. Disposable pads worn in underwear may be enough protection if you are prone to smaller accidents. Waterproof underwear is another safeguard to help keep clothing from getting wet. If nighttime accidents are a concern, disposable pads can be placed on the bed to protect the mattress.
Loss of urine can be irritating to the skin. Keep skin clean and dry. Ask your doctor for recommendations about cleansers that are gentle enough to be non-irritating to the area around the urethra. Creams are also available to help block the urine from the skin. If strong urine smell is distressing, deodorizing tablets are available to help cut down on odor.
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What Causes Urinary Incontinence In Men
Different types of incontinence have different causes.
- Stress incontinence can happen when the prostate gland is removed. If there has been damage to the nerves or to the sphincter, the lower part of the bladder may not have enough support. Keeping urine in the bladder is then up to the sphincter alone. The sphincter may be too weak to hold back the urine. And any extra pressure from sneezing, coughing, or straining can cause urine to leak.
- Urge incontinence is caused by bladder muscles that squeeze so hard that the sphincter can’t hold back the urine. This causes a very strong urge to urinate. Doctors don’t know why this happens. But sometimes it can be caused by other urinary problems.
- Overflow incontinence can be caused by something blocking the urethra, which leads to urine building up in the bladder. This is often caused by an enlarged prostate gland or a narrow urethra. Over time, the bladder gets so full that pressure builds up and forces the extra urine to move past the blockage and out of the bladder. Overflow incontinence may also happen because of weak bladder muscles.
In men, incontinence is often related to prostate problems or treatments.
Drinking alcohol can make urinary incontinence worse. Taking prescription or over-the-counter drugs such as diuretics, antidepressants, sedatives, opioids, or non-prescription cold and diet medicines can also affect your symptoms.
Why Does Pregnancy Cause Incontinence
During pregnancy, your body goes through a lot of physical changes. As your uterus stretches to hold the growing baby, a few things happen. Your bladder can be squished by the expanding baby, making your bladder hold less than before. You might experience an increased urgency to pee during pregnancy because your bladder cannot hold as much as before. This might become even more challenging towards the end of pregnancy when the baby is at its largest.
Another reason for incontinence during pregnancy is the weakening of your pelvic floor muscles. These muscles are the support structures for all of the organs in your pelvis. During pregnancy, they can be stretched and weakened as your uterus expands.
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Can Stress Urinary Incontinence Be Cured Or Reversed
There are many treatment options for SUI, and in many cases, symptoms can be improved or eliminated. A lot depends on the cause of your SUI, the severity, and your method for treating SUI. Physical therapy can do wonders, but its something you need to keep up with and not all patients are able to be compliant with their treatment. Surgery can also help with symptoms, but not everyone experiences complete recovery from SUI after surgery. Its important to talk to your doctor about your specific condition, the treatment options youre considering, and what you can expect.
How Do I Do Kegel Exercises
Kegel exercises are a simple way to build strength in your pelvic floor muscles. These exercises are done by lifting, holding and then relaxing your pelvic floor muscles. You can find these muscles by stopping the flow of urine mid-stream while youre urinating. Only do this until you learn how to find the muscles stopping the flow of urine mid-stream isnt healthy over a long period of time.
When youre doing Kegel exercises, start small. Only hold it for a few second. Over time you can slowly work your way up to longer and longer stretches of holding the muscles tight.
Unlike other types of workouts, no one can tell when youre doing Kegel exercises. Aim to do several sets of Kegel exercises twice a day.
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Studies In Patients With Fi
Eleven studies examined 12 interventions for patients with FI , one study in women only, nine with more than 77% women, and one where the majority of included participants was male .
Results are reported in Additional file : Table S14 and an overview of the summary of cure rates is reported in Table . All cure rates for all follow-up points within each study reported in the included studies are listed in Additional file : Table S14. The summary table lists all cure rates at the final follow-up for each study. In the text below, pooled results for each intervention are reported as specified in the Methods section.
Table 4 Cure ratesa in studies for female and male patients with fecal incontinence
The median cure rate for female patients with FI following sacral neuromodulation was 38.6% . Methylcellulose plus loperamide was assessed in one study, with a cure rate of 46% at 3 months. In men, cure rates for biofeedback were 40.8% at 6 months, 35.8% at 3 years and 29% at 5 years follow-up.
No studies meeting inclusion criteria were found for the following interventions for FI: education of patient and/or caregiver, diet and eating pattern modifications, dietary fiber supplements, bowel habit training, rectal irrigation, continence products such as pads or anal plug for containment, PFMT, sphincteroplasty, artificial bowel sphincter, dynamic graciloplasty, antegrade continence enema, colostomy, magnetic anal sphincter, and puborectal sling.