Clinical Management of Urinary Incontinence in Women

Incontinence is a devastating condition affecting millions of American women. It is a source of embarrassment that results in women becoming reclusive and deciding not to engage in socialization. Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide Help is available. You don’t have to depend on Depends! This blog will discuss the problem and the treatment options for urinary incontinence.
Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed. I believe in going from tshe least invasive (behavioral modification) to more invasive (surgery) interventions is the best approach. Bladder retraining and pelvic floor muscle exercises are first-line treatments who present with urge incontinence or “I gotta go right now”! Medication with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful; however, because of adverse effects such as constipation and blurred vision and confusion, these agents are not recommended in older adults.

Pelvic floor muscle exercises or Kegel exercises are considered first-line treatment for stress incontinence or loss of urine with coughing, laughing or sneezing. Alternatives for treating stress incontinence include vaginal pessaries. At this time no medications are approved by the U.S. Food and Drug Administration for treating stress incontinence. Minimally invasive procedures injection of periurethral bulking agents, can be used if stress incontinence does not respond to less invasive treatments.

Third line treatment consists of surgical interventions, such as sling and urethropexy procedures, should be reserved for stress incontinence that has not responded to other treatments.

Bottom Line: Women suffering from urinary incontinence do not have to suffer and should speak to their doctor about treatment options. Usually some of the options are helpful and can make women comfortable and able to engage in most activities without the embarrassment of the loss of urine.

Non-Medical Treatments of Urinary Incontinence

Incontinence is a devastating condition affecting millions of American women. It is a source of embarrassment that results in women becoming reclusive and deciding not to engage in socialization. Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide Help is available. You don’t have to depend on Depends! This blog will discuss the problem and the non-medical treatment options for urinary incontinence.

WEIGHT LOSS
Women who are overweight or obese and who experience stress incontinence should be encouraged to lose weight, which has been shown to reduce the frequency of incontinence symptoms.32

BEHAVIORAL TREATMENTS
Pelvic floor muscle exercises are the mainstay of behavioral therapy for stress incontinence. Up to 38 percent of patients with stress incontinence alone who follow a pelvic floor muscle exercise regimen for at least three months experience a cure. Increased effectiveness is demonstrated in women undergoing longer training and in those following comprehensive clinic-based training rather than self-help booklets.
Manual feedback (palpating the pelvic muscles during the exercises) and biofeedback (using a vaginal or anal device that provides visual or audio feedback about pelvic muscle contraction) have been used to teach patients the correct technique. Weighted intravaginal cones have also been used for improving technique when women have difficulty identifying their pelvic floor muscles. Although these strategies may improve technique and, consequently, symptoms in the short term, there is no evidence that they result in higher rates of long-term improvement or cure than the exercises alone.

ELECTRICAL AND MAGNETIC STIMULATION
Electrical stimulation of the pelvic floor muscles with a vaginal or anal electrode can be used in women who cannot voluntarily contract pelvic floor muscles.13 This can be done at home and typically consists of two 15-minute sessions daily for 12 weeks. Medicare has approved its use in patients who have incontinence that does not respond to structured pelvic floor muscle exercise programs.

Extracorporeal magnetic innervation involves a series of treatments in which the patient sits, fully clothed, on a chair that generates a low-power magnetic field. Patients typically undergo two or three treatments per week for six to eight weeks. One early study showed this method to be most effective for women who have mild stress incontinence (i.e., using three sanitary pads per day or fewer). A more recent study found it to be more effective than sham treatment for women who are unable to generate adequate pelvic floor muscle contractions.

DEVICES
Vaginal inserts, including incontinence pessaries and incontinence tampons, can be used for treating stress incontinence in pregnant women, in those who are not surgical candidates, and in those whose symptoms have not responded to previous surgeries. Vaginal inserts compress the bladder neck and urethra, thus decreasing urine loss caused by stress incontinence. Although pessaries are not widely used, their associated risks and costs are low, and they achieve results quickly. There are few contraindications to pessary use (e.g., active pelvic infection, severe ulceration, allergy to product materials, noncompliance). Incontinence tampons, which also place pressure on the bladder neck, are available in Europe.
[corrected] Urethral plugs are devices that are inserted into the urethra to prevent urine loss during activities that cause stress incontinence (e.g., running). They are available in two lengths: 3.5 cm and 4.5 cm. There is limited evidence promoting or discouraging their use, and they are associated with a number of adverse effects, including urinary tract infection (occurring in up to 31 percent of women over a two-year period), hematuria or blood in the urine (3 percent), and migration into the bladder (1 percent). Despite this, multi-year studies indicate a high degree of patient satisfaction, and the likelihood of significant adverse effects diminishes with continued use.

Bottom Line: Urinary incontinence is a devastating problem affecting millions of American women. You don’t have to suffer in silence. Help is available; speak to your physician

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