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Urinary Incontinence

by Jeanette S. Brown, MD, and Janis Luft, NP, MSN

Pelvic muscle exercises, commonly called Kegel exercises, have been shown to improve urethral sphincter function and to inhibit unwanted bladder contractions. Such exercises can be useful in the management of both stress and urge incontinence. Exercises can be enhanced by the use of weighted vaginal cones (tampon-shaped devices that can help a woman identify which muscles to contract when practicing Kegel exercises) or biofeedback.

In biofeedback therapy, special sensors are attached to the abdomen, and a small probe is placed in the vagina or rectum to measure the muscles’ electrical activity while pelvic muscle exercises are performed. This activity is then translated into colored lines on a computer screen, which show a person if she is using the correct muscles. Biofeedback therapy takes place in a doctor’s office, and the person is also given exercises to practice daily at home.

Biofeedback therapy can also incorporate Pelvic Floor Stimulation (PFS), a technique in which the pelvic floor muscles are strengthened via painless electrical stimulation through a vaginal or rectal probe. If the technique is found to reduce urinary urgency or frequency, a PFS unit can be purchased for home use, where it is usually used twice daily for 15 minutes for several weeks, and then tapered off as symptoms decrease.

Urge suppression is a technique for managing sudden urgency and regaining control when the need to urinate is mounting. It involves remaining still, tightening and relaxing the pelvic floor muscles rapidly several times, breathing deeply, and distracting yourself with a mental activity (such as making lists or reading) until the strong urge to urinate wanes.

Bladder retraining uses scheduled visits to the toilet to help relearn normal bladder function. For instance, a person might wait 1 to 1 1/2 hours between trips to the bathroom, ignoring any urge to urinate or any leakage that occurs in the interim. As her body becomes used to waiting, she increases these intervals by half-hour blocks until she is urinating at a comfortable interval. As the interval between trips to the bathroom is gradually increased using this method, bladder capacity improves and leaking accidents are reduced.

It is reasonable to try behavioral treatments on your own. Further information on these techniques can be obtained from these resources. If you don’t have adequate improvement, or if you think you might benefit from biofeedback therapy or PFS, working with a physical therapist or nurse specialist trained in pelvic floor rehabilitation can be very helpful.

Drug therapy. There are several different drugs approved for the treatment of overactive bladder, all of which belong to a family called anticholinergics. Anticholinergics can block the chemicals that act on bladder nerves, decreasing unwanted bladder contractions. Drugs can offer significant relief and are safe, but they have side effects, the most common of which are dry mouth and constipation. It’s often necessary to go through a process of trial and error to determine which drug at what dose offers the best improvement in continence with the fewest or least bothersome side effects.

While there are currently no drugs approved by the Food and Drug Administration for the treatment of stress incontinence, several drugs are being studied for this problem and are expected to be approved in the near future.

Inserted devices.A pessary is a device that is placed into a woman’s vagina to support the uterus and/or bladder and rectum. When used to treat stress incontinence, a properly fitted pessary prevents urine loss by acting as a “backstop” and maintaining pressure within the urethra when it is challenged by coughing, sneezing, or exercise. A well-fitted pessary should not cause discomfort. The user is generally unaware of the presence of the device in the vagina.

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