Postural Incontinence Treatment

postural incontinence treatment

Postural incontinence, caused by changes to women’s pelvic floor muscles, often responds well to various interventions; among the most effective are supervised pelvic floor muscle training (PFMT) and techniques to avert urinary urgency114.

Women may initiate self-care by using absorbent pads, extra clothing, and avoiding certain situations which might trigger bladder leakage. But management goals and preferences may alter over time even after effective noninvasive treatment is provided.

Pessary

Pessaries are devices designed to treat pelvic organ prolapse. Made from medical-grade non-reactive silicone, rubber or latex materials and available in various shapes and sizes to meet the unique needs of each patient, pessaries provide effective relief from pelvic organ prolapse.

Pessaries are devices inserted into the vagina to support or stabilize its walls, improve tightness in pelvic floor muscles, and increase tension on pelvis tissues. Many women also report reduced symptoms like pain, bloating and vaginal leakage from using them.

POP medications cannot cure, but they may help manage and slow its progression in most women. While surgical repair offers more permanent solutions, medication may still be an option for patients who do not meet surgery eligibility criteria due to age, medical complications or other considerations.

The most frequently worn type of pessary is a ring pessary, available both with and without support, that can be worn throughout POP treatment. This simple device can be inserted by folding it in half and applying some lubricant to its tip for easier insertion (Fig. 1A).

Cube pessaries, with concave sides, are another type of pessary often used to treat milder prolapse conditions and can be worn throughout the day. These pessaries should only be worn as needed, though.

Gellhorn and shelf pessaries, which feature cube-like shapes, may also be useful when treating rectocele or cystocele.

Other pessaries come in the shape of doughnuts or can be folded in half and inserted into the vagina for support, providing relief for women with first-degree prolapse or history of stress urinary incontinence. These types of devices should only be used under medical advice.

These pessaries may be combined with a sling or artificial sphincter for more extensive pelvic floor repairs, though their use can sometimes prove challenging and may need frequent removal.

Recent research demonstrated that pessaries were safe and effective treatments for postural incontinence. Over 77% of women fitted with pessaries reported success after 3 months, as well as being satisfied with their care. A larger prospective study is needed to fully explore long-term effects.

Implants

Postural incontinence may be caused by many factors, including pelvic muscle weakness or loss of tone, urethral abnormalities, and inadequate support of the bladder. Treatment options for postural incontinence may include pelvic muscle exercises, pharmacotherapy, behavioral therapies (such as bladder training) and corrective surgery.

Implants can help treat both urge and stress urinary incontinence. Most frequently placed in the vagina, they typically contain an electrode or neurostimulator which activates muscles to decrease leakage risk.

Groen and colleagues conducted a pilot study on chronic pudendal nerve neuromodulation (CPNN), an alternative form of sacral neuromodulation, as an approach for treating urge urinary incontinence in women. Stimulation of the pudendal nerve can produce reductions in detrusor overactivity.

PST was performed on 14 patients with refractory detrusor over-activity as determined by urodynamic testing, and six responded positively; six women showed improvement after receiving CPNN therapy.

Under general anesthesia, the surgery involved implanting a quadripolar lead into either the right or left obturator foramen, with an electrode placed over the tibial nerve containing electrical and magnetic pulses to stimulate lower pelvic muscles.

Once positioned, an electrode is stimulated for approximately one hour before being taken away at the conclusion of each session.

Aetna recognizes percutaneous tibial nerve stimulation (PTNS) as medically necessary to address chronic non-neurogenic urinary voiding dysfunctions, including overactive bladder and urge incontinence. On average, individuals will require at least 12 treatments with PTNS to experience relief from their symptoms.

Aetna views permanent placement of an implantable sacral nerve stimulator as experimental and investigational for treating urinary incontinence (UI) and non-obstructive urinary retention due to unknown efficacy; hence Aetna does not cover removal from members suffering non-neurogenic urinary voiding disorders.

Sling

Sling surgery is an innovative surgical solution to alleviate or eradicate symptoms of stress urinary incontinence (SUI). It involves placing an internal synthetic mesh tape or sling that is either fastened with sutures or introduced via vaginal opening.

Synthetic slings are widely considered the go-to treatment option for mild to moderate SUI, yet they come with some drawbacks. Most significantly, erosion may occur over time when not properly maintained – fluids or bacteria could damage them over time and compromise its integrity.

Slings should not be treated as long-term solutions; they will need to be adjusted or removed periodically in order to keep skin from irritation and prevent UTIs. Furthermore, they can be difficult to clean properly and not very portable.

Slings may lead to complications like urethral stenosis or urinary tract infection (UTI), making the incontinence worse. People suffering from SUI can use absorbent pads and specially-padded undergarment that minimize its effect.

Other postural incontinence treatments include sacral nerve stimulation and tibial nerve stimulation – these techniques send electrical impulses directly into the brain that help control urges to urinate.

Devices designed to stimulate sacral nerves – typically found in the buttocks – by sending electrical current through them can improve how your bladder and pelvic floor muscles signal each other. Although this procedure can be painful and uncomfortable, some individuals report significant improvements or complete elimination of incontinence after receiving this therapy.

Transobturator sling surgery is the latest innovation in SUI surgery. This technique employs synthetic tape or sling that is inserted through vaginal opening rather than retropubic incision and does not anchor to the rectus fascia with sutures, which has proven significantly safer at protecting vaginal angles while improving outcomes 9 years post surgery.

Artificial Sphincter

An artificial urinary sphincter (AUS) is a postural incontinence treatment using a cuff to close off the urethra to prevent leakage of urine. This minimally invasive surgery costs approximately PS9000 per device with a typical hospital stay time of two days.

Stress incontinence (leakage of urine associated with coughing, sneezing or straining) that has not responded to other treatments is one of the primary indications for its use. The device features an inflatable cuff with pressure-regulating balloon and pump placed within the scrotum for ease of use.

Once the device has been deployed, patients need to squeeze the pump whenever they wish to void. Squeezing moves fluid from the cuff to the balloon and causes deflation; urine flows freely out. Once deflated, cuffs will automatically inflate again within 90 seconds.

The pump can be used by both men and women, and can be placed beneath either lower belly skin or in scrotum skin using minimal-touch technique, thus minimizing infection risk.

As this device is covered with an antibacterial coating, MRIs and dental procedures should generally be safe with it. If any dental work or catheter use will take place for an extended period, however, you must notify your healthcare provider that an artificial urinary sphincter exists.

Most patients can expect their artificial urinary sphincters to last seven to 10 years before needing additional surgery to replace it in another location. Should their device fail prematurely, additional surgery will likely be required for replacement in its place.

Depending on the severity of the urethral damage or device failure, additional surgery may be required to replace and/or remove your existing device with one suitable for replacement. Most often this operation is successful and no long-term issues arise as a result.

An artificial urinary sphincter may also help with mixed incontinence (leakage of both urine and urge incontinence). This condition is more prevalent among women than men and more difficult to treat effectively.

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