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Incontinence

Incontinence Treatment Options

Urinary incontinence occurs when the urinary system can’t properly control the storage of urine in the bladder and its periodic release. An adult who becomes incontinent will involuntarily release urine before finding a toilet, and sometimes even before knowing the bladder is emptying.

There are many possible treatments for incontinence, depending on the cause and the condition of the patient. In some cases, medication is available. At other times, the patient can be taught exercises and behavioral techniques to deal with the condition. Surgical procedures and medical devices are also available for correcting or managing the problem. Here are some of the various ways the condition can be addressed:

Medication

Oral medication is the initial course of treatment for urge incontinence. Oxybutynin chloride (brand name Ditropan), tolterodine (Detrol) and imipramine (Tofranil), an antidepressant, all work by relaxing the bladder. Side effects of all three can include dry mouth, dry eyes, constipation, blurred vision and, occasionally, the complete inability to urinate. The medication is not appropriate for patients with glaucoma. Ask your physician if medication is right for you.

Behavioral Techniques

Sometimes simple exercises and behavioral changes can treat or at least improve urinal incontinence.

Time voiding

If a patient is incontinent due to an overactive bladder, "time voiding" is a learned technique for emptying the bladder before it has a chance to overflow. The patient is taught to urinate on a tight schedule, whether or not the need is felt. Generally, the patient begins by urinating at intervals of as little as an hour and gradually increases the intervals to as long as every four hours if no accidents occur.

Kegel exercises

Kegel exercises involve strengthening of the pelvic floor muscles, which are the sling of muscles that support the bladder, uterus and rectum. These are the muscles you use for stopping your urinary stream in mid-flow. The patient is taught how to tighten and release those muscles, gradually strengthening them.

Surgical Treatments

There are a variety of surgical options for controlling all forms of urinary incontinence. Since all surgery has its risks - especially when the patient is older - it usually is considered only after all other options have been tried. Here are several of the most widely used procedures:

Stress Incontinence Surgery for Women

There are many procedures for treating urinary incontinence, most of which work by elevating the weakened bladder neck and repositioning the angle between the bladder neck and the urethra. The surgery is usually performed after making an incision in either the abdomen or the vagina under a local or general anesthesia.

The patient typically uses a catheter for at least a few days after surgery, and on rare occasions for as long as three months if the patient is able to urinate normally. The prognosis for success with this type of surgery is generally good, but your physician can give you a better idea of prognosis and your probable recovery time. Older women tend to experience more complications and are generally less responsive to this type of surgery.

Artificial Urinary Sphincter

This can be an effective treatment of stress incontinence for both men and women. Others whose condition can be improved with the artificial urinary sphincter include patients with spinal bifida, spinal cord injuries, and incontinence as a result of pelvic trauma, prostate surgery, or poor urethral function in women as a result of radiation therapy and failed surgical procedures for incontinence.

It involves having a silicone rubber device implanted so that it surrounds the base of the bladder. The device contains liquid that inflates and deflates much as an actual sphincter would contract and expand, but with a pump control that’s placed in the male scrotum or the female labia. When inflated, the device seals off the neck of the bladder. When the patient wishes to urinate, he or she manually diverts the liquid from the sphincter to the balloon reservoir, allowing the bladder to empty. The sphincter then refills in three to five minutes, once more sealing off the bladder.

Collagen Injection

This protein is perhaps best known as the material injected into lips to give them a more supple appearance. Collagen can similarly be used to bulk up the urethra, increasing its resistance in patients whose incontinence is caused by a weakening of the urethra.

Electrical Stimulation

When the problem is in the electrical impulse that sends the signal from nerve ending in the bladder to the brain, surgeons may implant a device that stimulates the nerve endings that control bladder function. This is a very promising new treatment for urge incontinence.

Barrier Devices

Today's adult diapers are thin, hard to detect, and provide a sanitary barrier. They can be used in tandem with other treatment methods or instead of other options, especially when the patient is too frail for surgery and other methods have been ineffective.

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Last Reviewed: May 14, 2007

Martin I Resnick, MD Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University