Bladder incontinence treatment options

Bladder incontinence is a common condition, characterized by the uncontrolled release of urine at inappropriate times. It affects millions of people worldwide and is estimated to affect 3 to 6 million people in the UK alone. People who are incontinent of urine often feel embarrassed by their condition, and studies have shown that many do not seek treatment, although the condition may be treatable, or even cured, with the help and advice of a physician. There are many causes of incontinence in adults. Women are two times as likely to be affected than men. Many people also have the mistaken impression that incontinence is a natural step in the aging process; however, it is not considered a normal part of aging. There are many treatment options available for those who suffer from bladder incontinence. The following article will outline some of the common treatments of incontinence.

Self-help Practices

Self-help practices are simple measures that patients may try safely and in the comfort of their own home. These measures may be the first that a patient tries, and may even be all that is needed to control bladder incontinence. Some simple things to try are:

• Eliminating Caffeine- cutting down or eliminating caffeine may decrease or stop incontinence, as caffeine is an irritant to the bladder
• Losing Weight- if the patient is overweight, they may find their symptoms improve with weight loss
• Reducing Fluid Intake- decreasing fluid intake may be helpful if the patient drinks fluids excessively; however, cutting down on fluid intake too much can cause bladder infections, so it is best to discuss fluid intake with a physician
• Bladder Training- bladder training simply refers to the practice of voiding on a schedule and slowly increasing the time between voids. This can help strengthen weak bladder muscles. It may take several weeks before the patient notices any improvement in symptoms
• Avoidance of Constipation- patients who are frequently constipated may find their bladder incontinence improves when their bowels are regular. Hard stools in the bowel may put pressure on the urinary tract and worsen incontinence.

Physical Therapy

Physical therapy may offer help to patients with bladder incontinence:

• Kegel Exercises- These easy-to-perform exercises can be performed anywhere and at any time the patient chooses. Kegel exercises are used to isolate and strengthen the muscles of the pelvis that support the bladder and urethra. Performing exercises to strengthen these muscles may lead to improved control and less leakage of urine. They are performed by tightening and releasing the muscles that start and stop the flow of urine. Kegels should be performed 3 times a day and patients should work up to doing 10 repetitions of the exercise at a time. As with bladder training, it may take some time before patients see results.
• Biofeedback- Biofeedback involves using sensors that help the patient become more aware of when they are using the right set of muscles in the pelvic floor. This method is more commonly used in women.
• Vaginal Cones- Women may benefit from the use of vaginal cones, which are small weights that are placed in the vagina. To use the cones, women perform pelvic floor exercises while holding the cone in place. Cone weight can be gradually increased, which helps to increase the strength of pelvic floor muscles.

Medications

Medications to treat bladder incontinence in women are aimed at relaxing the bladder, making it less likely to contract involuntarily. Side effects are usually mild, and the medications are generally well tolerated.

Medications used to treat incontinence in men usually perform one of three functions: relax the smooth muscle of the bladder and prostate, inhibit production of hormones thought to be responsible for prostate enlargement, and relieve bladder spasms. As in women, these medications are usually well tolerated with few side effects.

Patients who wish to try the medication route will need to be seen by their family doctor, who may want to perform tests to try to determine the cause of the incontinence and to help decide which medication is the most appropriate to treat their bladder incontinence.

Surgery

Surgery is generally considered a last resort in the treatment of bladder incontinence, although there are exceptions. When the incontinence is severe and decreases the patient’s quality of life to a great extent, surgery may be the only option if other treatments are unsuccessful.

Common procedures done to relieve incontinence in women include the bladder sling and injections of bulking agents. The bladder sling creates a “sling” around the neck of the urethra and bladder and helps to provide support and to keep the urethra closed. This prevents the leakage of urine when patients cough, sneeze, or perform other activities that increase intra-abdominal pressure. Injection of a bulking agent into the tissue surrounding the urethra provides support to the urethra and prevents leakage of urine.

In men, surgical options generally involve the prostate. If the prostate is enlarged, surgeons may perform a TURP (transurethral resection of the prostate), an instrument called a resectoscope is inserted into the urethra and the prostate is debulked. In prostatectomy, the entire prostate is removed. This is usually done due to cancer of this organ.

Although bladder incontinence is a common problem, affecting millions of people, it need not be a condition that must be simply tolerated. Patients should consult their family physicians for advice on the problem. There are several treatment options that patients may try at home, such as decreasing or eliminating caffeine, losing weight, decreasing fluid intake, bladder training, and avoiding constipation. These simple measures may be all that is needed to decrease episodes of incontinence. Physical therapy interventions may include Kegel exercises, biofeedback training, and (in women) vaginal cones. Medications and/or surgery may be used to treat bladder incontinence if self-help methods fail.

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