Treatment Options

Treatment Options

1 in 3 women will experience urinary incontinence at some point in their lives. This means that treatment options need to be readily accessible and affordable. There are several options available that can aid bladder control, improving your quality of life, and leaving you happy, dry and confident.

A few simple lifestyle changes could significantly decrease incidences of incontinence, such as weight loss, regular exercise, and reducing caffeine intake. Although these are simple solutions, they are not always completely or immediately effective. If these options are not viable or working for you, it may be time to consider alternative treatments.

Urethral Bulking

This outpatient procedure involves 3 to 4 injections of a soft gel at various sites in the urethral wall. This gel prevents urine leakage by restoring the natural pressure needed to close the urethra. The procedure takes 5-10 minutes and has a success rate of up to 83%. The recovery time is minimal and there are only minor potential short-term complications, with only a 10% recurrence rate once performed. Meducat Medical promotes Bulkamid which offers much higher success rates and almost no complications at all.

Mesh Tape

This is a more invasive surgery, involving a synthetic mesh tape which is inserted via two incisions, and which, once healed, supports the urethra, thereby reducing the risk of leakage. Although only a day surgery, the recovery period can be up to 4 weeks. This procedure has a success rate of up to 90%, but as with any invasive operation, has a number of short- and long-term risks, including pain, urinary infection and erosion of the mesh.

Colposuspension

Before less invasive treatment options were available, this method was the most commonly performed, and many women still opt for the procedure despite potential complications and extended recover period. The surgery is performed through up to four keyhole incisions and involves stitching the lower vaginal tissue to a ligament behind the pubic bone, thereby lifting the bladder neck and creating pressure which reduces the risk of urinary leakage. Due to its invasiveness, the surgery requires up to 5 days in the hospital, and 6 weeks of at home recovery. Risks associated with the operation include pain, urinary infection, wound infection, vaginal and abdominal discomfort, and vaginal prolapse.

Autologous Tissue Sling

This procedure involves taking a strip of tissue from the abdominal wall and placing it beneath the urethra like a hammock, which provide additional support and aids in preventing incontinence. It is quite a lengthy procedure, taking over an hour in theatre, and can take 2 days before approved for discharge, after which there is an additional 6 week recovery period. The success rate is up to 90%, but potential complications include vaginal and abdominal pain, as well as infection.

Biofeedback Therapy

Help from Technology

Biofeedback is a type of therapy in which electrical patches are placed over areas of the body to record muscle contractions. The signals are then visualized on a computer screen. A technician can help you isolate the necessary muscles using biofeedback. This real-time information allows you to know whether or not you’re performing the routine correctly. Once you have the technique down, you’ll be able to perform Kegel exercises on your own without the help from biofeedback.

Effectiveness of Biofeedback

Biofeedback is effective for both common forms of this disorder. A review of more than 24 different studies involving more than 1,500 affected women concluded that those who received biofeedback in addition to pelvic floor muscle training were much more likely to report improvements or cures of their condition compared to those who received pelvic floor muscle training alone.

However, it is unknown whether the increase in successful outcomes was due to the addition of biofeedback or the extra time that women spent with healthcare professionals during the sessions.

Kegel Exercises for Women

Strengthening pelvic floor muscles can reduce or even cure symptoms of stress incontinence. Kegel exercises target the muscles that control the flow of a stream of urine. You need to do the routine regularly to attain and maintain maximum benefit. Kegel exercises are relatively easy to do; it just takes a little practice to make sure the patient is concentrating their efforts on the right area.

Pessary Use

A pessary is a device used to treat this problem. The device is inserted into the vagina by a doctor or nurse. The pessary pushes into the vaginal wall, affecting the position of the urethra so that leaks are less likely. A pessary may be used as a nonsurgical option to treat certain kinds of pelvic organ prolapse. Some pessaries are meant to be worn continuously. Others may be used as needed, for example only during gruelling exercise.

Pessary Fitting and Type

Pessaries can be difficult to insert and remove, so frequent medical visits, usually once every 2 to 3 months, are required so that the doctor or nurse can remove, clean, and reinsert the device. Patients who are allergic to silicone or latex may not be candidates for pessaries. The patient is asked to urinate before being fitted for a pessary. It is recommended to use the largest pessary that fits comfortably.

How to Do Kegel Exercises

To perform Kegel exercises, the patient must contract the muscles they use to stop a stream of urine. Hold for 3 seconds and then release. Relax for 3 seconds. Work up to 3 sets of 10 Kegels. The patient can start performing these workouts while lying down. As they get stronger, they can do them while sitting or standing. If they are having trouble isolating the correct muscles, a doctor, nurse, or physical therapist can help them with their technique.

As with any form of exercise, doing them regularly is critical to their success. Many women do not have the motivation or the time for Kegels and therefore aren’t able to reap the benefit of these exercises.

Nerve Stimulation

If behavioural and lifestyle interventions do not bring relief of urinary incontinence, electrical nerve stimulation may be an option to consider. Small devices implanted near the tibial nerve in the ankle or the sacral nerve in the lower back deliver impulses that help relieve urinary incontinence symptoms. Stimulation of the tibial nerve interrupts the impulses from the bladder that go to the brain. Stimulation of the sacral nerve may improve blood flow to the bladder and make pelvic muscles that control the bladder stronger. Nerve stimulation may also trigger the relief of chemicals that block pain.

Botox Injections

If a neurological condition is contributing to the issue, Botox injections to the bladder may provide relief by decreasing bladder contractions.

Drug Treatments

Drug Classes

Medications to treat urinary incontinence fall into several major classes. Antispasmodics decrease bladder contractions in an attempt to minimize leaks. These medications are available in pill form. Some are available as extended release forms or transdermal patches. Tricyclic antidepressants dampen nerve signals and decrease spasms in the bladder, both of which may decrease urine loss. Antidiuretic hormone is prescribed to help the body retain water. Taking antidiuretic hormone makes the urine more concentrated.

Medication Side Effects

The drugs prescribed to treat urinary incontinence may be associated with side effects. Antispasmodics may cause an increased sensitivity to light, decreased sweating, and dry mouth. Wearing sunglasses will help shield the eyes from bright light. Sucking on hard candy or chewing gum can provide relief from dry mouth. If the patient doesn’t sweat very much, they need to take extra care to drink plenty of fluids and avoid overheating, especially in warm weather. If side effects of medications are dangerous or bothersome, the patient must discuss this with their doctor who can adjust the dose or prescribe another drug that may have fewer side effects.

Vaginal Toning Devices

These are very new on the market. These devices are home-use devices which appeal to many patients. They use the combination of heat (up to 41oC), sonic vibration and LED light therapy to improve and strengthen the vaginal tissue.

Meducat Medical sells this device in the South African market. Patient feedback is extremely positive and the company that manufacture the product have published very promising data in a leading International Urogynaecology  Journal. The product is called vSculpt and is extremely easy to use. It promises to become a more attractive option than Kegal exercises for women. In that it not only works on the muscles it also works at a cellular tissue level and has the added benefit of improving moisturisation in the vagina which is extremely helpful in the menopausal woman. Little effort is required by the patient in doing this “pleasurable” treatment which most likely improves patient compliance.

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