Monday, June 5, 2023

How Do You Treat Stress Incontinence

Will Urinary Incontinence Go Away On Its Own

Treating stress and urge incontinence from home

There’s no doubt that urinary incontinence affects your quality of life. Leakages can not only irritate your skin and cause embarrassment, but constantly worrying about when one might happen next can keep you from living your life. So much so that you might plan everything you do around whether there’s a bathroom nearby.

It’s a very common problem affecting up to one in three women. If you’re experiencing urinary incontinence, you’re likely looking for answers. Specifically, what can you do to stop it?

“Urinary incontinence is a loss of urine when you’re not actively trying to urinate,” explains Dr. Fiona Lindo, urogynecologist at Houston Methodist. “It can happen without you being aware or with physical exertion, such as exercise or even when simply standing up, coughing or laughing.”

“Unfortunately, urinary incontinence isn’t likely to go away on its own. The good news, however, is that there are things that you can do on your own to improve it, and there are plenty of options for treating it,” adds Dr. Lindo.

Types Of Urinary Incontinence

Research shows that about 1/5 of women experience some kind of incontinence after their first vaginal birth, and over 1/3 of women experience incontinence after a forceps delivery. There are actually several different types of urinary incontinence. But for the sake of this discussion, lets cover the two types most common in mothers. These two are called stress incontinence and urge incontinence.

Stress incontinence is the leakage of urine during some physical activity. This could include laughing, coughing, sneezing, lifting, or exercising. To resolve stress incontinence, one needs to address the central stabilizing system and the way a woman manages pressure and load. This can mean changes in the strategy used to perform an activity. Or it might involve adopting a different posture to perform the offending task. For some women, it is as simple strengthening, but for others, it becomes more complex.

Urge incontinence is the leakage of urine accompanied by the feeling that you need to empty your bladder but cant get to the toilet fast enough. Similarly, an overactive bladder involves the same urgency, but with or without incontinence. It also includes increased frequency of urination both during the day and at night. According to research, an overactive bladder affects 17% of women over the age of 18 in the United States. This is more than the rates of diabetes and asthma.

Is Incontinence More Common In Women

Incontinence is much more commonly seen in women than in men. A large part of this is because of pregnancy, childbirth and menopause. Each of these events in a womans life can lead to bladder control issues. Pregnancy can be a short-term cause of incontinence and the bladder control issues typically get better after the baby is born. Some women experience incontinence after delivery because of the strain childbirth takes on the pelvic floor muscles. When these muscles are weakened, youre more likely to experience leakage issues. Menopause causes your body to go through a lot of change. Your hormones change during menopause and this can alter your bladder control.

Men can also experience incontinence, but it isnt as common as it is in women.

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Treatment Options For Urgency Incontinence:

  • Pelvic floor physical therapy This therapy helps to retrain the bladder.
  • Medications A range of medications can help you hold your bladder for longer and decrease your urinary frequency symptoms.
  • Botox injections in the bladder Botox relaxes the wall of your bladder in order to prevent it from contracting when it’s not supposed to.
  • Peripheral nerve stimulation This treatment uses a needle to stimulate a nerve in your foot that travels up the leg to the spine, where it connects with the bladder and calms it down.
  • Sacral neural modulation In this outpatient surgical procedure, a bladder pacemaker is implanted to help control how the bladder is stimulated by the sacral nerve.

“Regardless of which type of incontinence you’re experiencing, it’s important to get evaluated simply because there are so many options for treating urinary incontinence,” says Dr. Lindo. “We always start with conservative treatment approaches, but if those don’t work, you don’t have to continue to suffer. We can help to improve your quality of life.”

Unsupervised Pelvic Floor Training

Stress Incontinence Treatment &  Diagnosis

As we saw above, unsupervised pelvic floor muscle training is not the recommended best approach for treating stress incontinence, but for some women it can still be very effective.

Importantly, if you do not see an improvement in your symptoms, or your symptoms worsen, I would recommend you take a break from your home exercise efforts and seek out the guidance of a pelvic health physiotherapist. If you suffer from mild to moderate stress incontinence there is still an excellent chance that appropriate cueing and strengthening can significantly reduce or eliminate your symptoms.

Here are some of pelvic floor strengthening tools pulled directly from the toolbox of pelvic floor physiotherapists that can help you stop stress incontinence:


How to stop stress incontinence with Kegels:

  • Perform the Kegel exercise two times per day. Do not do this while going to the bathroom.
  • Get in a comfortable sitting or lying position and make sure you can locate your pelvic floor . Depending on your position you may find that you have more or less difficulty performing a full pelvic floor contraction. Experiment to find a position that works optimally. For example, being in a pelvic tucked under position with too much body weight into your buttocks may make it difficult for you to contract the front of your pelvic floor, while tipping the pelvis forward a bit to achieve a more neutral spine, may help.

    Vaginal weights
    Vaginal contraction trainers


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    What Causes Urinary Incontinence

    Urinary incontinence can be caused by many different medical problems, including weak pelvic muscles or diabetes. Some common causes are listed below.

    • For women, thinning and drying of the skin in the vagina or urethra, especially after menopause
    • For men, enlarged prostate gland or prostate surgery
    • Weakened and stretched pelvic muscles after childbirth
    • Certain medicines
    • Diseases such as diabetes, Alzheimers disease, and multiple sclerosis

    How To Do Kegels To Prevent Incontinence

    To get started: Find the right muscles. To identify your pelvic floor muscles, stop urination in midstream. Perfect your technique. To do Kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if youre lifting the marble. Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Repeat three times a day.

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    What Is Urinary Incontinence

    Urinary incontinence is the loss of bladder control. This means that you cant always control when you urinate. Urinary incontinence can range from leaking a small amount of urine to having very strong urges to urinate that are difficult to control. This can be embarrassing, but talk to your doctor about it. It can be treated.

    Millions of adults in the United States have urinary incontinence. Its most common in people older than 50 years of age, especially women. But it can also affect younger people, especially women who have just given birth.

    Be sure to talk to your doctor if you have this problem. If you hide your incontinence, you risk getting rashes, sores, skin infections and urinary tract infections. Also, you may find yourself avoiding friends and family because of fear and embarrassment.

    What Are The Symptoms Of Stress Incontinence

    How Can Physical Therapy Treat Incontinence?

    The main symptom of stress incontinence is a leakage of urine at times of physical movement or activity. Examples of the kinds of activities associated with urine leaking include laughing, coughing, lifting, or exercise. The leakage may be as little as a drop or two, or may be a “squirt,” or even a stream of urine.

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    Pelvic Floor Muscle Training

    Also known as Kegel exercises, these exercises can strengthen your urinary sphincter and pelvic floor muscles. These exercises can both improve stress incontinence, and prevent the condition from worsening. They can also help suppress the urge to urinate. In order to see tangible results, exercises must be done regularly and with the correct technique. Sometimes, it might help to initiate the program with specialized trained physical therapist.

    How Is Incontinence Treated

    There are many different factors that your healthcare provider will consider when creating a treatment plan for your incontinence. The type of incontinence and the ways it affects your life are both big considerations. Your provider will also talk to you about the type of treatment you are most comfortable with. There are three main types of treatment you can explore for incontinence medications, lifestyle changes and surgery. Each option has pros and cons that your provider will discuss with you.

    Medications to treat incontinence

    There are quite a few medications that can reduce leakage. Some of these drugs stabilize the muscle contractions that cause problems with an overactive bladder. Other medications actually do the opposite thing relaxing muscles to allow your bladder to empty completely. Hormone replacement therapies can often involving replacing estrogen thats decreased during menopause may also help restore normal bladder function.

    In many cases, medications can work very well to return normal function to the bladder. Your provider will carefully select a medication that matches your specific needs. Often, your provider will start you on a low dose of the medication and then increase it slowly. This is done to try and reduce your risks of side effects and to keep track of how well the medication is working to treat your incontinence.

    Common medications that can be used to treat incontinence include:

    Lifestyle changes to manage incontinence

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    Ways To Diagnose Incontinence

  • A physical examination. The doctor will completely check the areas that would be involved in incontinence in a man and a woman.
  • The blood test will be able to determine how well the kidney is functioning
  • A urinalysis to look for any abnormalities and infections.
  • An ultrasound to check the pelvis
  • A stress test
  • The X-ray that will help to see the function of the bladder which is called a cystogram.
  • A cystoscopy where a very thin tube is put into the urethra. A small camera is attached to the end of the tube and the doctor can check for abnormalities that may be inside the urinary tract.
  • A test that determines how much urine remains in the bladder after the person urinates.
  • Choice Of Intervention In Sui

    Sensible Urinary Incontinence remedies woman click to read ...

    Many factors should be considered when determining the optimal therapy for a patient with SUI. These include the etiology and type of SUI bladder capacity renal function sexual function severity of the leakage and degree of bother to the patient the presence of associated conditions, such as vaginal prolapse, or concurrent abdominal or pelvic pathology requiring surgical correction prior abdominal and/or pelvic surgery and, finally, the patients suitability for, and willingness to accept, the costs, risks, morbidity, and success rates associated with each intervention. The decision to treat symptomatic SUI with surgery should be made when the patients degree of inconvenience and/or compromised lifestyle are great enough to warrant an elective operation and nonsurgical therapy is either not desired or has been previously ineffective.

    There is no optimal therapy for all patients with SUI. However, the selection of an appropriate intervention for a properly motivated patient will most often result in an adequate improvement in symptoms. Oftentimes, the choice of intervention is made by the patient after appropriate diagnostic evaluation and counseling. Several therapeutic approaches may be appropriate for each patient with SUI. Interventions for one type of urinary incontinence, especially SUI, may not be applicable to other types of urinary incontinence .

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    What Are Some Of The Different Types Of Urinary Incontinence

    The following are some of the different types of urinary incontinence:

    • Urgency incontinence: This is the inability to hold urine long enough to reach a restroom. It can be associated with having to urinate often and feeling a strong, sudden urge to urinate. It can be a separate condition, but it may also be an indication of other diseases or conditions that would also warrant medical attention.

    • Stress incontinence: This is the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects or performing other body movements that put pressure on the bladder.

    • Functional incontinence: This is urine leakage due to a difficulty reaching a restroom in time because of physical conditions, such as arthritis, injury or other disabilities.

    • Overflow incontinence. Leakage occurs when the quantity of urine produced exceeds the bladders capacity to hold it.

    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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    Mechanisms Of Continence And Incontinence

    During bladder filling and urine storage, the bladder accommodates increasing volumes of urine from the upper urinary tract, with no significant increase in bladder pressure. During the filling phase, bladder or detrusor smooth muscle activity is normally suppressed by centrally mediated neural reflexes. In order to maintain continence, the bladder outlet and urethra must be closed at rest and remain so during periods of increased abdominal pressure. Normal bladder emptying occurs with a decrease in urethral resistance followed almost immediately by a volitional bladder contraction. Relaxation of the pelvic floor musculature and urinary sphincters and funneling of the bladder outlet permit urine to flow into the urethra. The rise in intravesical pressure should be of adequate magnitude and duration to empty the bladder almost completely.

    Treatments For Stress Incontinence In Women

    Treating Female Stress INCONTINENCE

    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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    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

    Strength of Recommendations

    Nighttime Voiding And Incontinence

    Nighttime voiding and incontinence are major problems in the older population. Women who have nocturia more than twice a night or experience nighttime bed-wetting may benefit from fluid restriction and the elimination of caffeine-containing beverages from their diet in the evening. Patients should restrict fluids after dinnertime so they can sleep uninterrupted through the night. In some cases, DDAVP can be used to decrease nighttime urine production and help reduce nocturia however use caution regarding the risk of hyponatremia, especially in elderly patients.

    Finally, individuals who develop edema of the lower extremities during the day experience nighttime voiding because excess fluid from lower extremities returns to the heart when the person is in a recumbent position. This problem may be handled with a behavior technique, support hose, and/or medications.

    Advise these individuals to elevate their lower extremities several hours during the late afternoon or evening to stimulate a natural diuresis and limit the amount of edema present at bedtime. Support hose or intermittent sequential compression devices used briefly at the end of the day can reduce lower extremity edema and minimize night time diuresis, thus improving sleep.

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