Urinary Incontinence Treatments
We offer a number of treatment options.
Non-Surgical Treatment of Urinary Incontinence
- Decreasing intake of fluids - women with bothersome urine loss are likely to benefit from limiting their fluid intake to a total of 50-60 ounces, per day provided they do not have a medical condition that prohibits limiting fluids.
- Avoiding or decreasing certain types of fluid s- caffeinated beverages (e.g.,colas, teas, and coffee), alcohol or acidic juices (e.g., grapefruit juice, orange juice).
There are different types of bladder training to improve symptoms of stress and urge incontinence. The type of training recommended by the nurse or doctor will have to do with your ability to move without any difficulty.
- Classic bladder training (habit training): Typically this type of training is used for women with symptoms of an overactive bladder- urgency, frequency or urge incontinence. This type of training includes first keeping a bladder diary and then setting up a voiding schedule to slowly increase the interval between voids (time between void). At weekly intervals, the voiding interval is increased by 15 minutes. The goal is to eventually void every 2 to 3 hours. Important in this training is learning to suppress the urge to void before the scheduled time. Performing pelvic floor contractions (Kegels) is one way to suppress the urge. This therapy trains the bladder to delay voiding for larger time intervals and has been proven effective in treating urge and mixed incontinence.
- Timed voiding: this type of training, unlike habit training fixes intervals for patients to empty their bladder. This type of bladder training in commonly used when the doctor prescribes medication for overactive bladder.
- Prompted voiding: The care giver prompts the incontinent patient to go to the bathroom every 2-4 hours. This puts the patient on a regular voiding schedule. The goal is simply to keep the patient dry and is a frequently recommended therapy for frail elderly, bedridden or Alzheimer's patients. Note: There are multiple pads commercially available specifically for incontinence.
- Pelvic muscle rehabilitation (Kegel Exercises): This technique involves pelvic muscle exercises (PME). PME may be used alone or in conjunction with biofeedback therapy, vaginal weight training, pelvic floor stimulation
- Pessaries: A pessary is a device worn in the vagina to help support the prolapsed organ. Pessaries come in many different shapes and sizes and must be fitted by a doctor. While a pessary may ease your symptoms it does not repair the prolapse. A pessary can be taken in and out either on a daily, weekly or monthly basis. This will depend on you and your doctor. It does, however, need to come out periodically for cleaning.
- Urge incontinence (overactive bladder): Medications to treat undesired bladder contractions include tolterodine (Detrol), oxybutynin (Ditropan), solifenacin (Vesicare), and darifenacin (Enablex). These medications block the receptors on the bladder responsible for contraction. This allows more urine storage before undesired contractions occurs.
- Stress incontinence: Symptoms can be improved with medications such duloxetine (Cymbalta) and imipramine (Tofranil). These medications can increase the activity of the muscle surrounding the urethra (the tube that carries urine from the bladder to the outside).
Surgery for Urinary Incontinence
InterStim® Therapy for Urinary Control
We offer this minimally invasive, two-staged treatment for patients with bladder control problems, such as urge incontinence and voiding dysfunction (inability to empty the bladder). The Interstim device, which is similar to a pacemaker, was originally approved in 1999 with significant improvements in the past decade. It is also approved by the FDA for bowel leakage (fecal incontinence).
Trial of InterStim® Therapy
A thin flexible wire is inserted into the anus where the sacral spinal nerve is located near the tailbone. This wire is attached to an external test stimulator that can be worn on a waistband. This device, which can fit into the palm of your hand, causes sacral nerve stimulation, which helps the bladder, the sphincter and the pelvic floor muscles to work more effectively together. During the two-week trial period patients adjust the intensity of the current until they find the right balance between an overactive and inactive bladder.
Long-term InterStim® Therapy
If you experience a 50 percent or more improvement in bladder function during the trial, an outpatient procedure where a neurostimulator is placed under the skin in the upper buttock. The neurostimulator is connected to a wire that sends mild electrical pulses to the sacral nerves to continue to help with your urine incontinence issues.
Vaginal Surgery: Slings
Sling procedures are surgeries used to treat stress urinary incontinence symptoms. A piece of tissue or artificial mesh is placed underneath the urethra. It acts as a layer of support so that the urethra is closed off when there is increased pressure in the abdomen (for example, laughing, coughing, sneezing and exercising). Materials commonly used include a patient’s own fascia (the tough covering around muscles), a piece of animal tissue specially treated for human use, or polypropylene mesh.
The following are common sling procedures:
- Pubovaginal sling uses a piece of a patient’s own fascia (autologous) or piece of animal tissue. It requires a small abdominal incision ranging from 5-10 centimeters (2-4 inches) on the lower abdomen.
- Tension-free Vaginal Tape (TVT, Gynecare) uses a mesh which is placed behind the pubic bone and exits on the lower abdomen within the hair-bearing area of the mons in two 1cm (1/2 inch) incisions. Learn more about the vaginal tape procedure (PDF).
- Transobturator Tension free Vaginal Tape (TVT-O, Gynecare) also uses a mesh. It differs slightly from the TVT. The mesh is directed around the pubic bones to exit at about the crease of the inner thigh from a one-centimeter (1/2 inch) incision.
Interested in Urinary Incontinence Treatment?
Call today to schedule a visit with one of our pelvic floor specialists. (Available in Northridge or Zion Crossroads.)