Stress Incontinence Treatment: Natural Biofeedback, Medications, and Surgery

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Stress Incontinence Treatment: Natural Biofeedback, Medications, and Surgery

Stress Incontinence Treatment 

Several types of treatment are available for stress incontinence. Treatment includes a wide range of options from lifestyle changes to medications, nonsurgical treatments, and in more severe cases, surgery to correct the urethra and pelvic floor. 

 

Natural Urinary Incontinence Treatments 

  • Make regular trips to the restroom to reduce the chance of urine leakage. 
  • Avoid caffeine like coffee, tea, energy drinks, and sodas. 
  • Exercise regularly and maintain a healthy weight. 
  • Losing weight can help take pressure off your stomach, bladder, and pelvic organs. 
  • Stop smoking: this includes cigarettes, vapes, and chewing tobacco. 
  • Fluid management. This means drinking less fluid during the day which helps the bladder manage.
  • Bladder training. You can set a schedule for toileting if you have mixed incontinence. 
The following may make your stress incontinence worse due to bladder irritation:
* alcohol
* caffeine
* soda
* chocolate
* artificial sweeteners
* tobacco or cigarettes

Stress Urinary Incontinence Medication

 
There are currently no approved medications to specifically treat stress incontinence in the United States. However, the antidepressant duloxetine (Cymbalta, Drizalma Sprinkle) is used for the treatment of stress incontinence in Europe. Nausea is the most common side effect that makes people stop taking the medication. Symptoms of stress incontinence quickly return when the drug is stopped.
 
Please always consult directly with your primary doctor or physician before taking any medication as side effects differ from person to person. 
 
Your doctor may prescribe medications that reduce bladder contractions, for stress incontinence. These include drugs such as:
* Imipramine
* Duloxetine
Your doctor may also prescribe mediation designed to treat an overactive bladder, for urge incontinence, such as:
* Vesicare
* Enablex
* Detrol
* Ditropan

Nonsurgical Stress Incontinence Treatments 

 

Kegel exercises and pelvic floor muscle therapy

Kegel exercises may help strengthen your pelvic muscles by essentially doing pelvic floor physical therapy. To do these exercises, you have to squeeze the muscles that stop the flow of urine. They involve identifying the pelvic muscles (pretend you are trying to avoid passing gas, we all know how this feels like), contracting them for a few seconds, relaxing, and then releasing. Repeat this motion 10 or more times, and doing this several times a day (see How to perform Kegel exercises). Some women find that using vaginal weighted cones helps boost the power of their pelvic floor exercises. Some research has shown that doing Kegel exercises during and after pregnancy may reduce your chances of developing urinary stress incontinence. Yoga and Pilates are also known to be helpful in strengthening the pelvic floor.

Biofeedback for pelvic floor strengthening

A biofeedback device can help you identify pelvic floor muscles and learn to strengthen and control them. For women, the therapy uses small sensors that are placed inside or around your vagina and on your abdomen. Your doctor will have you try certain muscle movements that help identify the pelvic floor muscles. The sensors record your muscle activity to help you identify the specific muscles required to do exercises to help strengthen your pelvic floor and improve bladder function. Additionally, using an electrical stimulator at home can help men and women who aren't able to effectively exercise their pelvic floor muscles. The device delivers a small electric current that makes the pelvic muscles contract painlessly. Biofeedback is a type of therapy that is used to increase awareness of your pelvic floor muscles for exercising and strengthening therapies.

Vaginal Pessary

This procedure requires a small ring be placed inside your vagina. A specialized urinary incontinence pessary, shaped like a ring with two bumps that sit on each side of the urethra, is fitted and put into place by your doctor or nurse. It helps support your bladder base to prevent urine leakage during activity, especially if your bladder has dropped (prolapsed). It will support your bladder and compress your urethra. Your doctor will fit you with the correct size vaginal pessary and will show you how to remove it for cleanings.

Urethral inserts 

This small tampon-like disposable device inserted into the urethra acts as a barrier to prevent leakage. It's usually used to prevent incontinence during a specific activity, but it may be worn throughout the day. Urethral inserts can be worn for up to eight hours a day. Urethral inserts are generally used only for heavy activity, such as repeated lifting, running, playing tennis, other active sports and cardio activity. 

Devices to Control Stress Urinary Incontinence in Men

Men may be offered a penile clamp/clip device to prevent SUI leaks. These external clamps may be used to restrict the flow of urine from the penis. Before buying this product, talk to your provider about the benefits or risks of using this device. Also, ask your healthcare provider about where you can buy this product.  

Stress Incontinence Surgery Options

When lifestyle changes, biofeedback, and other less-invasive treatments don't work, your doctor may recommend surgery if other types of treatments fail. Types of electable surgery include procedures such as the urethral sling, bladder neck suspension, or implantation of an artificial sphincter can stop stress incontinence. Here are some possible options of surgery to correct urinary incontinence: 

Injectable Therapy

The injection of tiny beads or particles suspended in gel around the urethra can help men who have had their prostates removed and women with the type of stress incontinence known as intrinsic sphincter deficiency, in which the urinary sphincter no longer closes completely and allows urine to leak out, particularly with exertion. Doctors inject bulking agent into your urethra in order to thicken the area and reduce incontinence or leaks.

Artificial Urinary Sphincter

The most effective treatment for male SUI is to implant an artificial urinary sphincter device. This surgically implanted inflatable artificial sphincter device is used to treat men. A cuff, which fits around the upper portion of the urethra, replaces the function of the sphincter. Tubes connect the cuff to a pressure-regulating balloon in the pelvic region and a manually operated pump in the scrotum. This device has three parts:
1. A fluid-filled cuff (the artificial sphincter), surgically placed around your urethra.
2. A fluid-filled, pressure-regulating balloon, inserted into your belly.
3. A pump you control inserted into your scrotum.
The artificial urinary sphincter cuff is filled with fluid which keeps the urethra closed and prevents leaks. When you press on the pump, the fluid in the cuff is transferred to the balloon reservoir. This opens your urethra and you can urinate. Once urination is complete, the balloon reservoir automatically refills the urethral cuff in 1-3 minutes. Artificial sphincter surgery can cure or greatly improve urinary control in more than 7 out of 10 men with SUI. Results may vary in men who have had radiation treatment. They also vary in men with other bladder conditions or who have scar tissue in the urethra.

Sling Surgery for Urinary Incontinence for Women

Midurethral Sling

The midurethral sling is the most common type of surgery used to correct SUI. The sling is made out of a narrow strip of synthetic mesh that is placed under the urethra with a variety of techniques: retropubic, transobturator and single-incision. Your doctor will recommend which anchoring location is right for you and review risks. This surgery is short and recovery may be shorter than with an autologous sling. There are additional risks associated with using mesh that you should discuss with your surgeon.

Autologous sling

In this type of surgery, the sling is made from a strip of your own tissue (autologous) taken from the lower abdomen or thigh. The ends of the sling are stitched in place through an incision in the abdomen. To use your own body tissue for a sling, an additional incision is made in the lower belly or in the thigh to collect tissue that will used for the sling. Autologous sling surgery is usually done through a cut in the bikini line. The surgery is most often done in less than 2 hours. This surgery does require more time to recover than a mid-urethral sling surgery.

Tension-free Vaginal Tape (TVT)

Doctors place a mesh around your urethra to give it support.
 

Sling Surgery for Urinary Incontinence for Men

Similar to female mid-urethral slings, the male sling is a narrow strap made of synthetic mesh that is placed under the urethra. It acts as a hammock to lift and support the urethra and sphincter muscles. Most commonly, slings for men are made of surgical mesh. The surgical incision to place the sling is between the scrotum and rectum. The male sling is most often used in men with mild to moderate SUI. It is less effective in men who have had radiation therapy to the prostate or urethra, or men with severe incontinence.
 

Bladder Neck Suspension

Bladder Neck Suspension is also called Retropubic Suspension, Colposuspension or Burch Suspension.
In this surgery, sutures are placed in the tissue along the side of the bladder neck and urethra and attached to a ligament along the pubic bone. This supports the urethra and sphincter muscles to prevent them from moving downward and accidentally opening. There are certain risks with this surgery, as with all surgery, that should be discussed before making your decision. The surgery can be done open or laparoscopically under general anesthesia in less than a few hours. it requires more time to recover than mid-urethral sling surgery. This surgical procedure uses sutures attached to ligaments along the pubic bone to lift and support tissues near the bladder neck and upper portion of the urethra. This surgery can be done laparoscopically or through an incision in the abdomen. This Rrtropubic colposuspension surgery moves the bladder and urethra back into their normal positions.

After Care for Stress Incontinence Surgery 

 
The goal of any treatment for incontinence is to improve your quality of life. Surgical treatments usually work, especially when combined with lifestyle changes. Make sure you rest for a few weeks to allow for recovery and healing. Continue with daily Kegel exercises to maintain pelvic muscle strength. Ideally, you should maintain a healthy weight and diet. A large amount of weight gain or activities that strain your belly and pelvis can harm surgical repair over time.
Stay in touch with your healthcare provider/surgeon about follow-up care. Typically, you will be asked to visit your surgeon between six weeks and six months after surgery for a follow-up visit to make sure that everything is going smoothly. Your bladder may also be tested to see how well its releasing urine and if urine remains in the bladder after going to the bathroom. If leaking symptoms remain or if you have any pain, let your surgeon know right away. Keep in mind that the medical devices implanted with surgery may need adjustments over time.

Coping and Support for Urinary Incontinence

Treatments for stress incontinence can often substantially reduce, and possibly eliminate, urine leakage. Some people will still have urine leakage every now and then. Being prepared for this possibility may help you cope and manage the symptoms in your day to day life. Here are a few ideas to make urinary incontinence management easier to handle: 
  • Maintaining your connection with family, friends and co-workers can prevent feelings of isolation and depression that can accompany incontinence. 
  •  Stock up on supplies. Take along sufficient incontinence pads or protective undergarments and possibly a change of clothes. Incontinence products are discreet and can be stowed in a roomy purse or a small backpack. Extra supplies and spare clothes can be kept in the trunk of your car or a backpack for use when needed. You will be relieved to have a spare set of clothes in the case of any emergency. 
  • Scout out your destination. Familiarize yourself with the restrooms available at your destination. Choose seating that allows easy access to restrooms in places like restaurants, movie theaters, and sporting stadiums.
  • Talk with your partner. As difficult as this may be initially, be upfront with your partner about your urinary incontinence symptoms. A partner's understanding and willingness to accommodate your needs can make your symptoms much easier to handle, and help you feel supported through your daily life. 
  • Empty your bladder at regular times. To reduce your chances of leakage, avoid drinking fluids for an hour or so before bedtime and empty your bladder before having to sit down for prolonged periods of time.
  • Do your Kegel exercises. These exercises strengthen your pelvic floor muscles and reduce urine leakage.
  • Be prepared. Using a protective mattress pad or using disposable bed pads on your bed may ease your worry and contain any leakage during the night, and prevents a load of soiled laundry in the morning.

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