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.
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.
When Should You Call Your Doctor
See your doctor immediately if your urinary incontinence does not go away or is accompanied by:
- Weakness or numbness in your buttocks, legs, and feet.
- Fever, chills, and abdominal or flank pain.
- Blood in your urine or burning with urination.
- A change in your bowel habits.
- You have a problem with urinary incontinence that is getting worse.
- Uncontrolled loss of urine is enough of a problem that you need to wear an absorbent pad.
- Incontinence interferes with your life in any way.
Do not be embarrassed to discuss incontinence with your doctor. Incontinence is not an inevitable result of aging. Most people with incontinence can be helped or cured.
If you have a sudden change in your ability to urinate and you are not sure if it is related to your urinary incontinence, see the topic Urinary Problems and Injuries, Age 12 and Older.
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Stress Incontinence Treatments & Remedies
Luckily, there are a lot of things you can do to treat stress incontinence. Most of them involve minor tweaks to your daily routine, making them quite doable. Hereâs a list of some stress incontinence remedies and treatments:
Stay Hydrated on a ScheduleThough it may be tempting to drastically limit fluid intake for fear of leaking urine, this is not advised. Donât limit fluids to the point of dehydration. Instead, drink prescribed amounts throughout the day in order to avoid overstressing your bladder with a large amount of fluid all at once.
Get MovingShedding some extra weight can help alleviate the symptoms of stress incontinence by removing one of its root causesâbeing overweight. Even a daily walk around the block to get moving can go a long way in chipping away at the pounds.
Pelvic Floor ExercisesStress urinary incontinence is a result of a weakened pelvic floor. Your pelvic floor is a system of muscles, nerves and ligaments that acts like a supportive basket for your bladder, uterus and anus. Kegel exercises are commonly used to strengthen the pelvic floor muscles. Kegels involve flexing and releasing the muscles used to hold in urine so they get stronger.
Doing pelvic floor muscle training three times a day can help alleviate stress urinary incontinence over time. Here is a sample routine for kegel exercises:
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
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Clinical Management Of Urinary Incontinence In Women
This is a corrected version of the article that appeared in print.
LAUREN HERSH, MD, and BROOKE SALZMAN, MD, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Am Fam Physician. 2013 May 1 87:634-640.
Patient information: A handout on this topic is available at .
Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide. 1 Estimations of prevalence range from 3 to 55 percent, depending on the definition and the population.2 Within nursing homes, 60 to 70 percent of patients experience the disorder.3 These estimates are thought to be conservative, because at least one-half of patients do not report incontinence to a physician.4
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Conservative therapies should be the first-line treatment for stress and urge urinary incontinence.
|Clinical recommendation||Evidence rating||References|
Pharmacologic interventions should be used as an adjunct to behavioral therapies for refractory urge incontinence.
Surgical therapy should be considered in women with stress incontinence that has not responded to less invasive treatment modalities.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Conservative therapies should be the first-line treatment for stress and urge urinary incontinence.
Classification of Urinary Incontinence in Women
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.
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Will I Have Incontinence For My Entire Life
Sometimes incontinence is a short-term issue that will go away once the cause ends. This is often the case when you have a condition like a urinary tract infection . Once treated, frequent urination and leakage problems caused by a UTI typically end. This is also true for some women who experience bladder control issues during pregnancy. For many, the issues end in the weeks after delivery. However, other causes of incontinence are long-term and related to conditions that are managed throughout your life. If you have a chronic condition like diabetes or multiple sclerosis, you may have incontinence for a long period of time. In those cases, its important to talk to your provider about the best ways to manage your incontinence so that it doesnt interfere with your life.
A note from Cleveland Clinic
It can be embarrassing to talk about bathroom habits with your healthcare provider. This embarrassment shouldnt stop you from treating incontinence, though. Often, your healthcare provider can help figure out the cause of your bladder control issue and help make it better. You dont need to deal with it alone. Talk to your healthcare provider about the best ways to treat incontinence so that you can lead a full and active life without worrying about leakage.
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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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.
Stress Incontinence Causes Symptoms And Treatment
Do you pee a little when you cough, sneeze or exercise? You may have stress incontinence. Learn about its causes, symptoms and treatment options.
If you dread laughing, coughing, sneezing or lifting heavy objects because of accidental urine leaks, you may have stress incontinence. Stress incontinence is the most common type of adult urinary incontinence in women.
More than 1 in 3 women suffer from incontinence, and many women are younger than you may think. Contrary to popular belief, urinary incontinence doesn’t just impact older adults. The changes that a womanâs body goes through is a natural part of life and those changes can result in stress incontinence.
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.
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.
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What Is Urinary Incontinence In Men
Urinary incontinence is the accidental release of urine. It’s not a disease. It’s a symptom of a problem with a man’s urinary tract.
Urine is made by the kidneys and stored in a sac made of muscle, called the urinary bladder. A tube called the urethra leads from the bladder through the prostate and penis to the outside of the body. Around this tube is a ring of muscles called the urinary sphincter. As the bladder fills with urine, nerve signals tell the sphincter to stay squeezed shut while the bladder stays relaxed. The nerves and muscles work together to prevent urine from leaking out of the body.
When you have to urinate, the nerve signals tell the muscles in the walls of the bladder to squeeze. This forces urine out of the bladder and into the urethra. At the same time the bladder squeezes, the urethra relaxes. This allows urine to pass through the urethra and out of the body.
Incontinence can happen for many reasons:
- If your bladder squeezes at the wrong time, or if it squeezes too hard, urine may leak out.
- If the muscles around the urethra are damaged or weak, urine can leak out even if you don’t have a problem with your bladder squeezing at the wrong time.
- You can also have incontinence if your bladder doesn’t empty when it should. This leaves too much urine in the bladder. If the bladder gets too full, urine will leak out when you don’t want it to.
- If something is blocking your urethra, urine can build up in the bladder and cause leaking.
Do Pelvic Floor Exercises Make A Difference
It takes time, effort and practice to become good at pelvic floor exercises/Kegels. It is best do these exercises for at least three months to start with. You should start to see benefits after a few weeks. However, it often takes two to five months for most improvement to occur. After this time you may be cured of stress incontinence. If you are not sure that you are doing the correct exercises, ask a doctor, physiotherapist or continence advisor for advice.
If possible, continue exercising as a part of everyday life for the rest of your life. Once incontinence has gone, you may only need to do one or two bouts of exercise each day to keep the pelvic floor muscles strong and toned up and to prevent incontinence from coming back.
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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 .
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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Unsupervised Pelvic Floor Training
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:
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