Urinary incontinence - Vejthani Hospital | JCI Accredited International Hospital in Bangkok, Thailand.

Urinary incontinence

Diagnosis

Recognizing the specific type of urinary incontinence you’re dealing with is essential, and often your symptoms can provide valuable insights for your doctor. This understanding will play a role in determining the most suitable treatment options.

Your medical provider will likely commence with a thorough physical examination and medical history assessment. Subsequently, you might be requested to carry out a prompt activity, like a cough, which can reveal instances of incontinence.

Your doctor will probably then advice:

  • Bladder diary. You keep a log of your daily activities for a few days, noting how much you drink, when you urinate, how much urine you make, if you had the need to urinate, and how many times you experience incontinence.
  • Urinalysis. Your urine sample is examined for any abnormalities, blood traces, or other indicators of infection.
  • Postvoid residual measurement. A container is provided for you to urinate (void) into in order to measure your urine flow. The remaining urine in your bladder is then measured by your doctor using an ultrasound or catheter. If you have a lot of pee in your bladder after urinating, you may have a blockage in your urinary tract or an issue with your bladder’s nerves or muscles.

In cases where more extensive information is required, your healthcare provider might suggest more comprehensive assessments like urodynamic testing, cystoscopy, and pelvic ultrasound. These examinations are typically conducted when surgical options are being considered.

Treatment

The approach to treating incontinence is influenced by its type, severity, and underlying cause. Sometimes, a combination of treatments may be necessary. If an underlying condition is identified as the root cause of your symptoms, your doctor will prioritize addressing that matter.

Your physician might suggest beginning with less invasive treatments and progressing to alternative options if these initial methods prove ineffective

Behavioral techniques

The following may be recommended by the doctor:

  • Make a scheduled of urinating every two to four hours instead of delaying until the urge arises.
  • Bladder training, to postpone urination once you feel the desire. Initially, you might try to resist the urge to urinate for 10 minutes at a time. The objective is to increase the interval between bathroom visits until you only need to urinate every 2.5 to 3.5 hours.
  • Double voiding, to assist you in learning to completely empty your bladder in order to prevent overflow incontinence. Double voiding entails urinating, waiting a little while, and then attempting again.
  • Controlling your intake of food and drinks, to take back command of your bladder. Alcohol, caffeine, and foods high in acid may need to be restricted or avoided. Losing weight, upping physical exercise, or cutting back on liquid intake can all help.

Pelvic floor muscle exercises

To strengthen the muscles that aid in urine control, your doctor might advise that you perform these exercises frequently. These methods, sometimes referred to as Kegel exercises, are particularly helpful for stress incontinence but may also reduce urge incontinence.

As you perform pelvic floor exercises, visualize yourself trying to halt the flow of pee. Then:

  • For five seconds, tighten (contract) the muscles you would use to stop peeing. Then, let them loosen for five seconds. (If this seems too challenging, begin by holding for two seconds and then relaxing for three.)
  • Practice holding each contraction for 10 seconds to eventually do so.
  • Aim to complete at least three sets of 10 reps each day.

Your healthcare provider might recommend collaborating with a pelvic floor physical therapist or experimenting with biofeedback techniques. These approaches can aid you in identifying and engaging the appropriate muscles effectively.

Medications

Commonly prescribed medications for managing incontinence include:

  • Topical estrogen. Toning and rejuvenation of tissues in the urethra and vaginal areas may be aided by the topical application of lowdose estrogen in the form of a vaginal cream, ring, or patch.
  • Anticholinergics. These drugs can control an overactive bladder and possibly aid with urge incontinence. These include trospium chloride, oxybutynin, tolterodine, darifenacin, fesoterodine, and solifenacin.
  • Alpha blockers. These drugs relax the muscles in the prostate and the bladder neck, making it simpler for men with urge incontinence or overflow incontinence to empty their bladder. Examples include doxazosin, silodosin, alfuzosin, and tamsulosin.
  • Mirabegron. This medicine can increase the amount of urine your bladder can hold and is used to treat urge incontinence. It relaxes the bladder muscle. Additionally, it might increase the amount of urine you urinate at a time, which would help you completely empty your bladder.

Electrical stimulation

To stimulate and strengthen your pelvic floor muscles, temporary electrodes are inserted into either your rectum or vagina. This mild electrical stimulation can be beneficial for both urge incontinence and stress incontinence, although multiple sessions spaced over several months might be necessary.

Medical devices

Devices made to cure incontinence in women include:

  • Pessary, a flexible silicone ring that fits around your vagina and is worn continuously. Women who have vaginal prolapse can also utilize the device. The urethra is supported by the pessary, which helps to stop urine leakage.
  • Urethral insert, a tiny, disposable item shaped like a tampon that is put into the urethra prior to a certain activity that can cause incontinence, such playing tennis. The insert serves as a stopper to stop leaks and is taken out before to urinating.

Interventional therapies

The following are some interventional treatments for incontinence:

  • Bulking material injections. The urethral surrounding  tissue is injected with a synthetic substance. The bulking substance prevents urine leaks by keeping the urethra tight. In general, more intrusive procedures like surgery are more effective than this method for treating stress incontinence. It might be necessary to repeat it more than once.
  • Botox. People with overactive bladders and urge incontinence may benefit from Botox injections into the bladder muscle. People are often only given Botox prescriptions if other treatments have failed.
  • Nerve stimulators. The sacral nerves, which control bladder function, are stimulated by two different types of devices using painless electrical pulses. One version connects to wires on the lower back through an implant beneath the skin in the buttock. A detachable plug that is put into the vagina is the alternative. If various treatments have failed to reduce overactive bladder and urge incontinence, the sacral nerves can be stimulated.

Surgery

If alternative treatments prove ineffective, various surgical approaches can target the underlying causes of urinary incontinence:

  • Sling procedures. A pelvic sling is made from synthetic material (mesh) or strips of your body’s tissue and is placed beneath your urethra and the bladder neck, which is the area of enlarged muscle where the bladder joins to the urethra. When you cough or sneeze, the sling especially helps keep the urethra tight. Stress incontinence is treated using this technique.
  • Prolapse surgery. Surgery may combine a sling treatment with prolapse surgery in patients who have pelvic organ prolapse and mixed incontinence. Even when pelvic organ prolapse is repaired, symptoms of urine incontinence may not always get better.
  • Artificial urinary sphincter. To maintain the urinary sphincter closed until there is a need to urinate, a tiny, fluidfilled ring is inserted around the bladder neck. You deflate the ring and let pee from your bladder flow when you squeeze a valve implanted beneath your skin.
  • Bladder neck suspension. Your urethra and bladder neck, a region of thickened muscle where the bladder joins to the urethra, are intended to receive support from this surgery. Since it requires an abdominal incision, general or spinal anesthetic is used during the procedure.

Absorbent pads and catheters

If medical treatments are unsuccessful in resolving your incontinence, you can utilize measures to alleviate the discomfort and inconvenience of urine leakage:

  • Pads and protective garments. The majority of products are discreetly wearable beneath everyday clothing and maintain a similar profile to regular underwear. For men experiencing issues with urine dribbles, a drip collector is an optiona compact pouch of absorbent padding worn over the penis and held in position by snugfitting undergarments.
  • Catheter. Your doctor could advise you to learn how to insert a soft tube (catheter) into your urethra several times a day to drain your bladder if you are incontinent because your bladder doesn’t empty properly. You’ll be shown how to properly clean these catheters so they may be reused.