Urinary incontinence affects both men and women of any age, although older adults are most at risk. Treatment typically begins by visiting your primary care doctor.
Your doctor can diagnose urinary incontinence through a comprehensive history and physical exam, along with lifestyle modifications like losing weight, quitting smoking and restricting alcohol. Lifestyle modifications may also help manage bladder control by way of losing weight or not smoking and restricting alcohol intake.
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Vaginal Pessary
Pessaries are small ring-like devices designed to fit comfortably inside the vagina and support tissues displaced by pelvic organ prolapse. Available in various shapes and sizes to meet different anatomy types, a health care provider will perform an exam to ascertain its severity as well as which pessary would best help manage symptoms.
Pessaries may be used alone or combined with sling procedures to treat urinary incontinence due to pelvic organ prolapse in elderly female patients, with 88% showing improvements after using an artificial urinary sphincter and pessary.
Ring or cube pessaries can be easily inserted and removed by patients themselves, while others like Gellhorn or Impressa pessaries require professional healthcare staff to use a tubular introducer to insert. Lubricants may be recommended by physicians to ease this process.
As a rule, women with pessaries should have regular follow-up appointments every one to three months with their healthcare provider in order to detect signs of irritation such as redness or bloody discharge that indicates misfitting, friction, or infection. Healthcare providers will also check for damage such as cuts or abrasions as well as its ability to support the uterus, bladder, and rectum.
Fillers
Urinary incontinence is not a natural part of aging and there are various treatments available. Most nonsurgical, nonpharmacological therapies target pelvic muscles and behaviors that influence bladder function while pharmaceutical solutions focus on bladder innervation and sphincter muscle relaxation. Kegel exercises (to strengthen the muscles that control bladder and urethra function), pelvic floor muscle training to increase time between feeling the urge to urinate and actually passing urine, and bladder training (teaching people how to hold in urine until the need arises) are just some examples of treatments available for urinary incontinence.
Medical devices to reduce urinary leakage or avoid accidents related to incontinence are available as well. This includes the urethral insert – a small, disposable tampon-like device that plugs the urethra before being taken off before urinating; pessaries worn inside the vagina to support the urethra to stop urine leakage; artificial urinary sphincters implanted around the bladder neck which remain closed until needed; artificial urinary sphincters; and artificial urinary sphincters which remain closed until needed to urinate;
A GP or healthcare professional may use a bladder ultrasound to assess how full your bladder is and identify potential conditions that cause urinary incontinence, such as prolapsed bladder. They may ask you to keep a diary of symptoms relating to urinary incontinence; if these changes don’t help, they may refer you to an NHS continence service run by specialist nurses called continence advisers and physiotherapists.
Botulinum Toxin Injections
Botox is an injectable form of botulinum toxin, a substance which temporarily paralyzes muscles. When administered intravenously into your bladder, Botox injections may partially paralyze those responsible for involuntary urine contractions (urgency and urge incontinence). While this treatment may help alleviate symptoms associated with overactive bladder syndromes, such as spinal cord injuries or multiple sclerosis, they will not treat other causes of incontinence such as these.
If your incontinence is caused by detrusor muscles contracting too frequently, sacral nerve stimulation might be recommended. This process involves placing a small device near one of your sacral nerves at the base of your spine. An electric current then flows from this device directly to one or more sacral nerves located there and improves how signals travel between your brain and these muscles, helping control the urge to pee.
Recent research conducted at a tertiary urogynecology center revealed that injections of bovine-derived botulinum toxin type A showed significant improvements in urinary incontinence symptoms for both younger and elderly patients suffering from neurogenic overactive bladder, though its impact was less evident on elderly subjects. This may be related to decreased baseline bladder compliance and higher PdetQmax associated with age, but further study is required to better understand how this therapy can be optimized for older populations. Injections tend to be well tolerated with only mild, transient side effects such as mild bruising and dot-like marks at injection sites. General medical risks associated with injections may include deep vein thrombosis and pulmonary embolism which may arise if injections are given outside of the bladder.
Neuromodulation Devices
Urinary incontinence affects 25 million Americans. This condition occurs when your bladder and urethra leak urine without your conscious control, often occurring more often as we get older. Urinary incontinence is considered medical issue and can be treated using behavioral therapy, medication, surgery or nerve stimulation techniques.
Your specific type of urinary incontinence will dictate its treatment plan. Your physician will conduct a comprehensive physical exam and order lab tests to help identify your issue, before possibly referring you to an urogynecologist or urologist specializing in female pelvic health and urinary tract conditions.
Behavioral therapies are generally the first line of defense against urinary incontinence, such as bladder training to resist urges to void and gradually increasing intervals between voiding. Toileting assistance techniques like schedules, habit training and prompted voiding can also be effective treatments for urinary incontinence. Furthermore, diet changes such as eliminating bladder-irritant foods may be beneficial.
Many surgical devices are designed to help improve or cure urinary incontinence. Examples include catheters designed to drain the bladder; vaginal pessary rings that apply pressure against leakage; or intraurethral plugs – however a Cochrane review found limited evidence from controlled trials as to their efficacy in improving incontinence.
Sling Procedure
Stress urinary incontinence (SUI) occurs when muscles that support the urethra and bladder neck become compromised, leading to physical activity-induced slipperiness of the urethra that results in urine leakage from within.
Surgery offers effective SUI treatment solutions for both women and men. For women, surgery often includes sling procedures to support the urethra using abdominal tissue or synthetic materials; retropubic slings require making a cut within the vagina; while transobturator slings involve several small incisions in the abdomen (laparoscopic surgery).
At this minimally invasive procedure, surgeons use human tissue or plastic fabric called mesh to form what’s known as a hammock around the urethra in order to support weak tissues near its urethral sphincter and stop urine leakage for many patients.
Studies comparing two midurethral sling procedures for SUI have revealed similar subjective cure rates of 85-95%; with retropubic sling having the slightly higher success rate. Both procedures resulted in bladder perforations requiring two days post surgery catheter use as preventative measures.
Bladder sling surgery may cause discomfort, but any discomfort should subside over the following few days or weeks with proper recovery instructions and avoidance of strenuous activities. If symptoms continue, seek medical advice – your urogynecologist can recommend medications, therapies or treatments tailored specifically to your situation that could prove helpful in helping manage any complications that arise from this surgery.
Retropubic Colposuspension
Urinary incontinence (UI) is an increasingly prevalent issue for both men and women alike, occurring when the muscle that regulates urine flow becomes weak or incompetent, compromising urinary sphincters (the control mechanism). UI poses serious health issues associated with reduced quality of life and an increased risk of institutionalization or mortality; prevalence increases with age. More frequently found among older adults.
Treatment for urinary incontinence depends on its nature and severity. Non-invasive therapies like pelvic floor exercises and bladder training may be sufficient. For severe cases, surgery is sometimes required – retropubic colposuspension being one of several effective surgical techniques available today.
Under laparoscopic or open surgery procedures, doctors make an incision (cut) in the lower part of your belly and suture both parts of the bladder neck and vaginal wall to elevate and lift both bladder and urethra, offering relief for stress incontinence. Laparoscopic techniques also may be utilized.
Studies indicate that open retropubic colposuspension has similar objective cure rates as sling operations and anterior colonporrhaphy for stress incontinence, with additional improvement seen in 10% of patients. More studies are necessary to ascertain long-term efficacy; minimal access sling procedures offer promising short-term results but require closer monitoring for adverse events – an especially crucial consideration in frail elderly patients. Preoperative urodynamic evaluation should always be considered prior to considering surgical treatments for stress incontinence.
