Thursday, February 2, 2023

What Can Be Done About Stress Incontinence

Choice Of Intervention In Sui

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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 .

What Is The Treatment For Urinary Incontinence

Specific treatment for urinary incontinence will be determined by your doctor based on:

  • Your age, overall health and medical history

  • Type of incontinence and extent of the disease

  • Your tolerance for specific medications, procedures or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include:

  • Behavioral therapies:

  • Bladder training: Teaches people to resist the urge to void and gradually expand the intervals between voiding.

  • Toileting assistance: Uses routine or scheduled toileting, habit training schedules and prompted voiding to empty the bladder regularly to prevent leaking.

  • Diet modifications: Eliminating bladder irritants, such as caffeine, alcohol and citrus fruits.

  • Pelvic muscle rehabilitation :

  • Kegel exercises: Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence.

  • Biofeedback: Used with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.

  • Vaginal weight training: Small weights are held within the vagina by tightening the vaginal muscles.

  • Pelvic floor electrical stimulation: Mild electrical pulses stimulate muscle contractions.

  • Medication :

  • Pessary

  • Office procedure

  • Slings

  • Bladder suspension

  • Consult your doctor with questions regarding the management and treatment of urinary incontinence.

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    Causes Of Urinary Incontinence

    Incontinence can happen for many reasons. For example, urinary tract infections, vaginal infection or irritation, constipation. Some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

    • Weak bladder muscles
    • Overactive bladder muscles
    • Weak pelvic floor muscles
    • Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinsons disease
    • Blockage from an enlarged prostate in men
    • Diseases such as arthritis that may make it difficult to get to the bathroom in time
    • Pelvic organ prolapse, which is when pelvic organs shift out of their normal place into the vagina. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak.

    Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:

    • Prostatitisa painful inflammation of the prostate gland
    • Injury, or damage to nerves or muscles from surgery
    • An enlarged prostate gland, which can lead to Benign Prostate Hyperplasia , a condition where the prostate grows as men age.

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    Medications For Urinary Incontinence

    If medications are used, this is usually in combination with other techniques or exercises.

    The following medications are prescribed to treat urinary incontinence:

    • Anticholinergics calm overactive bladders and may help patients with urge incontinence.
    • Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms.
    • Imipramine is a tricyclic antidepressant.

    How Is Urinary Incontinence Diagnosed

    What is Female Stress Incontinence

    For people with urinary incontinence, it is important to consult a health care provider. In many cases, patients will then be referred to an urogynecologist or urologist, a doctor who specializes in diseases of the urinary tract. Urinary incontinence is diagnosed with a complete physical examination that focuses on the urinary and nervous systems, reproductive organs, and urine samples.

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    What Are The Types Of Urinary Incontinence

    More than half of people with stress incontinence also have urge incontinence. Having both stress and urge incontinence is known as mixed incontinence. An overactive bladder causes urge incontinence. This type of urinary incontinence causes you to leak urine when you feel an urgent need to pee.

    Overflow incontinence is a different type of urinary incontinence. It causes you to leak urine because your bladder is too full or you cant completely empty it.

    Stress Urinary Incontinence Treatments

    Your treatment for stress urinary incontinence will depend on the severity of your symptoms. Many people find that introducing pelvic floor muscles can make a significant difference. If your symptoms are still troublesome, your GP can prescribe medication along with the exercises. As a final resort there are surgical treatments available, these will only be considered if your condition is severe and is causing an impact on your daily life. Your GP or Healthcare Practitioner will be able to advise on the best route of treatment for you.

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    How Do Health Care Professionals Find The Cause Of A Bladder Control Problem

    A health care professional will ask about your family and medical history and give you a physical exam. The exam will look for medical problems that may lead to accidental urine loss, also called urinary incontinence . You may be asked to cough while your bladder is full to see if you leak urine. This is called a stress test, and health care professionals use it to help diagnose stress incontinence.

    Additionally, you may be asked to keep a bladder diary, and your health care professional may order labs and other diagnostic tests.

    How Common Is Stress Incontinence

    What causes overactive bladder and what can be done about it?

    Stress incontinence is the most common type of urinary incontinence. It most often affects the urinary system in people assigned female at birth . As many as 1 in 3 people who were AFAB will experience stress urinary incontinence at some point. Its less common for the condition to affect men, but it does happen.

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    What Can Be Done

    Stress urinary incontinence treatment can be both surgically and non-surgically, depending on the exact nature of the incontinence. As the condition and anatomy of each patient differ, and the outcomes may vary.

    Changes to your diet, such as drinking less water and limited caffeine intake can help decrease the occurrence of urine leakage. Non-surgical options include physical therapy, fitness routine, pelvic floor muscle training, and vaginal pessaries.

    Traditional mesh slings, single incision mini-slings, retropubic colposuspension, and bulking are among the available surgical options for stress urinary incontinence treatment.

    If you have further questions, call Desert Sky Urology to discuss the available options for your condition. For SUI urology or SUI treatment in Phoenix, Chandler & Gilbert, AZ call us today and schedule an appointment.

    Tension Free Vaginal Tape

    This is a procedure that can be done as day surgery but is not normally recommended for those who are considering having children in the future. This involves threading tape through a small incision of the vaginal wall so that it supports the urethra. Click to find out more about tension free vaginal tape.

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    What Treatments Are Available To Me If My Incontinence Doesnt Go Away After A Year

    While kegels and behavioral therapy work well for most men with mild to moderate leaking, they may not be completely effective for some. Luckily, there are still some options for treating bladder leakage after prostate surgery.

    Another surgery is sometimes needed when bladder leaks persist for more than a year after surgery. This may consist of having a urethral sling procedure, or an artificial urinary sphincter.

    With a urethral sling procedure, a synthetic mesh tape is implanted to support the urethra. Up to an 80% improvement has been seen with this procedure and some men stop leaking completely.

    An artificial urinary sphincter is used in patients who have more severe urinary incontinence that is not improving, or for those patients who may have had a lot of damage to the sphincter muscle after prostate surgery. An artificial urinary sphincter is a mechanical ring that helps close the exit from the bladder.

    As will all surgeries, these come with pros and cons and potential complications. Be sure to discuss these options with your doctor.

    Supervised Pelvic Floor Training

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    I realize that this article is about self-help measures to stop stress incontinence, but understanding the differences between supervised and unsupervised pelvic floor strengthening is necessary for two reasons. First, supervised training is the widely accepted recommended approach so I would be doing a disservice not to mention it. Second, supervised training has been shown to be the more effective approach so if doing these exercises on your own fails to significantly improve your symptoms, all is not lost.

    In contrast to unsupervised pelvic floor muscle training, training supervised by a pelvic health physiotherapist offers:

  • Proper instruction on how to perform pelvic floor muscle exercises. Women with urinary incontinence are less likely to be able to feel and contract their pelvic floor muscles and are therefore more likely to perform muscle strengthening exercises such as Kegels incorrectly. In one study, over 30% of women with urinary incontinence were unable to appropriately perform a Kegel exercise without guided instruction, and instead mistakenly contracted abdominal, gluteal or hip muscles , which can in fact be counter-productive for their incontinence.
  • Better outcomes. Patients who receive targeted personalized training taught by specialized health care providers with regular follow-up, have a greater likelihood of significantly improving or curing their stress incontinence.
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    Talking To Your Doctor About Stress Urinary Incontinence

    NAFC is excited to debut a short film about coming to terms with incontinence. About just how challenging it can be to admit that there’s a problem. And also about how facing up to that reality can be an important first step towards drier days. Click above to watch the video.

    You may feel hesitant to speak with your doctor about urinary incontinence, but you can rest assured that your doctor has likely treated many people with this condition youre not the first and you certainly wont be the last to ask about SUI. Talking about your condition is the first step toward treatment, and its an important one, so its good to be prepared. Here are some things you can do to help make your visit more productive:

    What Matters Most To You

    Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

    Reasons to have surgery

    Reasons not to have surgery

    I’ve tried Kegel exercises, but they haven’t worked for me.

    I think that Kegels might work for me.

    I don’t want to wear absorbent pads or try a pessary to avoid leakage.

    I don’t mind wearing pads or trying a pessary.

    I’ve tried medicines, but they don’t work for me.

    I think that medicines might work for me.

    Stress incontinence lowers my quality of life.

    My quality of life is not too bad.

    I think surgery can help me.

    I don’t want to have surgery for any reason.

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    What Causes Urinary Incontinence

    Urinary incontinence is not an inevitable result of aging, but it is particularly common in older people. It is often caused by specific changes in body function that may result from diseases, use of medications and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop urinary incontinence during pregnancy and after childbirth, or after the hormonal changes of menopause.

    Home Remedies For Urinary Incontinence

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    Urinary incontinence can be described as the inability to control urination, leading to urine leakage or involuntary loss of urine.

    It is a very common, and at times debilitating, urological disorder. According to the National Association for Continence , it affects about 25 million Americans.

    Urinary incontinence can be divided into three main types:

    • Urge incontinence occurs when an overactive or hyperactive bladder causes a sudden and intense urge to urinate causing involuntary loss of urine
    • Stress incontinence occurs when physical activities like vigorous exercise, jumping, coughing, sneezing or even laughing put pressure on the bladder and it releases urine
    • Overflow incontinence inability to completely empty the bladder, leading to frequent or constant dribbling of urine

    Incontinence can be caused by a number of factors like age , weakened pelvic floor muscles due to surgery or childbirth, enlarged prostate, menopause, an overactive bladder, nerve damage, urinary stones, urinary tract infections and constipation.

    Plus, certain foods, drinks and medications may stimulate your bladder and cause temporary incontinence.

    It not only can cause discomfort and embarrassment, but can also be harmful if urine is left in the bladder creating a breeding ground for bacteria. Incontinence is not a disease in itself, but a symptom of an underlying condition or disorder.

    Here are the top 10 home remedies for urinary incontinence.

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    Why Do I Have Stress Incontinence In The First Place

    To understand how to stop stress incontinence its helpful to first understand a little bit about the most common causes of mild to moderate stress incontinence:

  • Weakness of pelvic floor muscles resulting in inadequate closure of urethral sphincters.
  • Damage of fascia or ligaments following pelvic trauma such as childbirth.
  • Sub-optimal communication between the nerves and muscles responsible for managing pressure change in the pelvis and abdomen .
  • Do The Right Exercises

    High-impact exercise and sit-ups put pressure on your pelvic floor muscles and can increase leaks.

    To strengthen your pelvic floor to relieve symptoms, replace high-impact exercise, such as jogging and aerobics, with strengthening exercise, such as pilates.

    Pilates strengthens your core muscles, which is beneficial for stress 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.

    Some General Lifestyle Measures Which May Help

    Stress Urinary Incontinence
    • 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.

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    How Do I Cope With My Fecal Incontinence

    Doing the following can help you cope with your fecal incontinence:

    • using the toilet before leaving home
    • carrying a bag with cleanup supplies and a change of clothes when leaving the house
    • finding public restrooms before one is needed
    • wearing absorbent pads inside your underwear
    • wearing disposable underwear

    Personal Stories About Choosing Treatments To Manage Stress Incontinence

    These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

    I started having stress incontinence after my son was born. My doctor showed me how to do some exercises to strengthen the muscles that help hold urine in. I know other women who have been helped by them. I am glad to have options other than surgery.

    Tina, age 39

    I thought I had tried everything for my stress incontinence. I can manage it most of the time, but when I jog, I get quite a bit of dribbling. I went to my doctor to find out whether there was anything I hadn’t tried or whether surgery was my only other option. We talked about a lot of options, including pelvic floor exercises. I am going to give those methods a try.

    Ever since I was in my 20s, I have leaked a little bit of urine when I cough or sneeze or exercise. After I had my kids, it seemed to get worse. I really wanted a solution that would take care of the problem all the time. Even though there are some risks, my doctor and I agreed that surgery was a reasonable choice for me.

    Faith, age 39

    At my last visit, my doctor and I talked about many aspects of getting older: the leaking urine, the weaker bones, the change in my hormones, and all that. I was surprised to learn about surgery to help with my urine leakage problem. It is good to know that so many women have had success from surgery.

    Carrie, age 55

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