Surgery For Stress Incontinence
If the less invasive treatments dont help you, your GP will refer you to a specialist to discuss surgery. The main types of surgery for stress incontinence include the following.
- Colposuspension. In this procedure your surgeon will lift the neck of your bladder by stitching the top of your vagina to the back of your pubic bone. Most people will have open surgery for this procedure.
- Sling procedure. In this procedure, your surgeon will place a piece of your own tissue under your urethra, and use it as a sling to support it.
- Injections of bulking agents into the wall of the urethra. This narrows your urethra, helping you to hold urine in your bladder. The effects of this procedure may wear off over time and you may need to have further injections.
- Artificial sphincters. If youve already had surgery for stress incontinence and this hasnt worked, you may be offered an artificial urinary sphincter.
Each procedure comes with risks and benefits. Its important to discuss these and any complications you might experience with your doctor before you agree to go ahead with the procedure.
Until recently, another treatment choice for some women was to have an operation using an artificial mesh, also known as a tape, to support your urethra. There are concerns about the safety of the procedure, so for now this type of operation has been suspended and is unlikely to be offered except in exceptional circumstances.
Treatment Of Urinary Incontinence
Treatment for incontinence usually starts with the least invasive treatments first. This means trying lifestyle changes, such as those listed in the self-help section above, as well as other treatments before thinking about surgery. The treatment you need depends on the type of incontinence you have.
Mixing Oxybutynin With Herbal Remedies And Supplements
There’s very little information about taking oxybutynin with herbal remedies and supplements. These remedies are not tested in the same way as medicines.
Some herbal medicines can make you feel sleepy, cause a dry mouth, or make it difficult to pee. Their effect is similar to oxybutynin. This can increase your risk of getting side effects or make your side effects worse.
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Symptoms Of Urinary Incontinence
The main symptom of urinary incontinence is leaking urine. But this can vary quite a bit, from leaking a few drops to partly or totally emptying your bladder.
If you have urge incontinence, youll feel a sudden urge to go to the toilet which you cant put off. You may not be able to make it to the toilet in time. Some women also need to go to the toilet at night and sometimes leak at night too.
If you have stress incontinence the main symptom is leaking urine when you do things like cough, sneeze, lift something heavy or exercise.
You may have other symptoms such as:
- needing to pass urine often
- a feeling of pressure in your vagina
- dribbling urine after youve been to the toilet
- it hurts or stings when you pass urine
How To You Test Stress Incontinence In Woman
Women may be examined for a rectal exam and a pelvic exam during a physical exam. An urine sample is used to test for infection, blood or other abnormal conditions. An examination of the neurological system should be conducted to identify any pelvic nerve problems. A urine stress test is a medical procedure that measures the loss of urine when you cough or bear down.
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Choice Of Intervention In Sui
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 .
Symptoms Of Urge Incontinence
Overwhelming Urges
Urge incontinence occurs due to overactivity of the detrusor muscle. The hallmark symptom of this kind of urinary incontinence is a sudden, overwhelming urge to void, accompanied by loss of urine. Frequent urination and nighttime urination often occur with this type of urinary incontinence. The amount lost is variable. Hearing running water or changing position may trigger bladder contractions and lead to urine loss. This type of incontinence can occur in anyone of any age, but it is more typical with advancing age. Just 9% of women between the ages of 40 and 44 suffer from urge incontinence while 31% of women over the age of 75 suffer from the condition.
Mixed Incontinence
Sometimes stress incontinence and urge incontinence occur at the same time. This is called mixed incontinence. People who suffer from urge incontinence lose greater amounts of urine than those who suffer from stress incontinence. Those who suffer from stress incontinence notice leaks with activities that increase abdominal pressure. Keeping a voiding diary, noting the time, place, and activities associated with symptoms of urine loss can help the physician determine whether you suffer from stress incontinence, urge incontinence, mixed incontinence, or another issue.
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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.
Am I At A Higher Risk Of Incontinence At An Older Age
Your body constantly changes throughout your life. As you age, the muscles that support your pelvic organs can weaken. This means that your bladder and urethra have less support often leading to urine leakage. Your risk for developing incontinence as you age might be higher if you have a chronic health condition, have given birth to children, went through menopause, have an enlarged prostate or have had prostate cancer surgery. Its important to talk to your healthcare provider over time about the risks of incontinence and ways you can manage it without interference to your daily life.
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What Should I Do About Anal Discomfort
Fecal incontinence can cause anal discomfort such as irritation, pain, or itching. You can help relieve anal discomfort by
- washing the anal area after a bowel movement
- changing soiled underwear as soon as possible
- keeping the anal area dry
- using a moisture-barrier cream in the area around your anus
- using nonmedicated powders
- using wicking pads or disposable underwear
- wearing clothes and underwear that let air pass through easily
Talk with your doctor or a health care professional about which moisture-barrier creams and nonmedicated powders are right for you.
Treatments For Bowel Incontinence
Bowel incontinence is usually treatable. In many cases, it can be cured completely.
Recommended treatments vary according to the cause of bowel incontinence. Often, more than one treatment method may be required to control symptoms.
Non-surgical treatments are often recommended as initial treatment for bowel incontinence. These include:
Diet
These steps may be helpful:
- Eat 20 to 30 grams of fiber per day. This can make stool more bulky and easier to control.
- Avoid caffeine. This may help prevent diarrhea.
- Drink several glasses of water each day. This can prevent constipation.
Medications
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Diagnosis Of Bowel Incontinence
Discussing bowel incontinence can provide clues for a doctor to help make the diagnosis. During a physical examination, a doctor may check the strength of the anal sphincter muscle using a gloved finger inserted into the rectum.
Other tests may be helpful in identifying the cause of bowel incontinence, such as:
Dosage And Strength Of Standard Tablets
Standard tablets come as either 2.5mg, 3mg or 5mg.
The usual starting dose of 2.5mg is 1 tablet, taken twice a day, in the morning or evening, or 1 tablet, taken 3 times a day.
If you take 3 doses a day, space each dose evenly throughout the day. You could take it first thing in the morning, in the middle of the afternoon and at bedtime.
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What Measures Can You Take To Help Clients With Urinary Incontinence
What Treatment Options Are Available If Urinary Incontinence Still Won’t Go Away
Seeing a urogynecologist as early as possible can help ensure that you have a complete understanding of your condition and treatments options.
“Both stress and urgency incontinence typically respond well to behavioral modifications, but if things are not improving, it’s best to get evaluated,” says Dr. Lindo. “This is why I always recommend seeing a specialist about your condition right away. You never want to play the guessing game with your health, especially when your condition affects your quality of life.”
In addition, your doctor can recommend a pelvic floor physical therapy program. While Kegels can play an important role in alleviating urinary incontinence, Dr. Lindo says they’re performed incorrectly more than 80 percent of the time.
“An incorrect Kegel will not help correct urinary incontinence,” warns Dr. Lindo. “Seeing a physical therapist who specializes in pelvic floor exercises can help ensure you’re performing Kegels and other exercises correctly and truly strengthening your pelvic floor.”
And if your condition continues to progress or worsen, your urogynecologist has expertise to perform testing and recommend a range of urinary incontinence treatment options and procedures that can help to correct your condition and address your specific situation.
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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.
Diagnosis Of Urinary Incontinence
If youre leaking urine and its upsetting you or affecting your day-to-day life, you should see your GP. You can also see a specialist pelvic health physiotherapist, or your GP may refer you to one.
Your GP will ask about your symptoms and medical history. This helps them find out which type of incontinence you have and rule out any underlying causes. Your GP will also ask about any medicines you may be taking.
Your GP should examine you too. Theyll feel your abdomen and probably do an internal examination. This means putting a finger into your vagina and asking you to squeeze your pelvic floor muscles. This can help to show how well theyre working.
Your GP may ask you to keep a bladder diary for a few days. This means writing down when you go to the toilet, how much urine your pass and whether or not you have any incontinence. Its best to fill in your diary on both work and non-working days to give a complete picture.
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Electrical And Magnetic Stimulation
Electrical stimulation of the pelvic floor muscles with a vaginal or anal electrode can be used in women who cannot voluntarily contract pelvic floor muscles.13 This can be done at home and typically consists of two 15-minute sessions daily for 12 weeks. Medicare has approved its use in patients who have incontinence that does not respond to structured pelvic floor muscle exercise programs.
Extracorporeal magnetic innervation involves a series of treatments in which the patient sits, fully clothed, on a chair that generates a low-power magnetic field. Patients typically undergo two or three treatments per week for six to eight weeks. One early study showed this method to be most effective for women who have mild stress incontinence .39 A more recent study found it to be more effective than sham treatment for women who are unable to generate adequate pelvic floor muscle contractions.40
What Is Bowel Incontinence
Bowel incontinence is when youâre not able to control your bowel movements. It’s a common problem, especially among older adults, and ranges from irregular stool leaks while passing gas to a total loss of control of your bowels.
Accidental bowel leakage isnât usually a serious medical problem. But it can dramatically interfere with daily life. People with bowel incontinence may avoid social activities for fear of embarrassment.
Many effective treatments can help people with bowel incontinence. These include:
- Medicine
Talking to your doctor is the first step toward freedom from bowel incontinence.
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Cautions With Other Medicines
Oxybutynin may affect the way other medicines work, and other medicines may affect how oxybutynin works.
Tell your pharmacist or doctor if you’re taking:
- amantadine, a medicine used for Parkinson’s disease or for infections
- levodopa, used to treat Parkinson’s disease
- phenothiazines, clozapine, haloperidol or benperidol, medicines for mental health problems
- donepezil, rivastigmine, galantamine or tacrine, medicines used for dementia
- amitriptyline, imipramine or dosulepin , medicines for depression
- medicines used to make you feel sleepy
- anti-sickness medicines like prochlorperazine
- medicines for stomach and bowel-related problems like domperidone and metoclopramide
- digoxin, quinidine or disopyramide, medicines used to treat heart problems
- dipyridamole, used to treat blood problems
- chlorphenamine or diphenhydramine, medicines used to treat allergies
- any medicines used to treat irritable bowel syndrome, asthma, incontinence, motion sickness or movement disorders related to Parkinson’s disease, that work in a similar way to oxybutynin
Common Questions About Tolterodine
Tolterodine is a type of medicine called an antimuscarinic muscle relaxant.
It works by relaxing the muscle that is found in the wall of the bladder. This helps to increase the volume of pee your bladder can hold and control the release of pee.
Tolterodine begins to work within 3 to 8 hours but it may take up to 4 weeks before it takes full effect. If the symptoms do not improve after 1 to 2 weeks, talk to your doctor.
Talk to your doctor if your symptoms get worse at any time.
Usually, you’ll need to take tolterodine for a long time.
After 4 weeks your doctor will check that tolterodine is helping your symptoms. They’ll also do a review every 6 to 12 months after that to check it’s still working for you.
Take tolterodine until your doctor tells you to stop. Do not stop taking it just because you feel better.
Do not take tolterodine for longer than you need to. Your doctor will check every 6 to 12 months that your treatment is still needed.
There may be an increased risk of confusion and possibly dementia in people taking tolterodine, but more study needs to be done. If you’re worried about this, talk to your doctor.
It’s safe to take tolterodine with everyday painkillers like paracetamol and ibuprofen.
If you want to stop taking tolterodine, talk to your doctor first.
If you’ve been taking it for at least 6 months, your doctor may suggest at your review that you can stop taking it for up to 4 weeks to see how your symptoms change without it.
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Symptoms Of Bowel Incontinence
Bowel incontinence may be a short-term problem or one that happens on a regular basis. You could suddenly feel the urge to use the bathroom or you might not be aware that you need to go . Bowel incontinence may also happen with other bowel problems such as:
- Loose, watery stool
- Trouble passing stool or irregular bowel movements
- Bloating and gas
Dosage For Tolterodine Tablets
Adults will usually take 2mg in the morning and 2mg in the evening. Leave a gap of 12 hours between doses.
Children will usually take between 1mg and 4mg a day.
If you are giving tolterodine to a child to stop bedwetting, the usual dose is 1mg taken at bedtime. The dose can be increased up to a maximum of 2mg twice a day, depending on response.
If you have kidney or liver disease, or you’re affected by side effects, your doctor may reduce your dose to 1mg twice a day.
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