Urinary incontinence non pharmacological treatment
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Non pharmacological treatment
Exercises
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce stress leakage.[1] Patients younger than 60 years old benefit the most.[1] The patient should do at least 24 daily contractions for at least 6 weeks. [1]
Vaginal cone therapy
A more recently developed exercise technique suitable only for women involves the use of a set of five small vaginal cones of increasing weight. For this exercise, the patient simply places the small plastic cone within her vagina, where it is held in by a mild reflex contraction of the pelvic floor muscles. Because it is a reflex contraction, little effort is required on the part of the patient. This exercise is done twice a day for fifteen to twenty minutes, while standing or walking around, for example doing daily household tasks. As the pelvic floor muscles get stronger, cones of increasing weight can be used, thereby strengthening the muscles gradually.
The advantage of this method is that the correct muscles are automatically exercised by holding in the cone, and the method is effective after a much shorter time. Clinical trials with vaginal cones have shown that the pelvic floor muscles start to become stronger within two to three weeks, and light to medium stress incontinence can resolve after eight to twelve weeks of use.
Electrical stimulation
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This can stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.
Biofeedback
Biofeedback uses measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
Timed voiding or bladder training
Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, the patient fills in a chart of voiding and leaking. From the patterns that appear in the chart, the patient can plan to empty his or her bladder before he or she would otherwise leak. Biofeedback and muscle conditioning--known as bladder training--can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.
Other procedures
Many people manage urinary incontinence with pads that catch slight leakage during activities such as exercising. Also, incontinence may be managed by restricting certain liquids, such as coffee, tea, and alcohol.
Finally, many people who could be treated resort instead to wearing absorbent, reusable undergarments which can hold 6 oz. or disposable diapers which can hold more. The reusable undergarments may be positive from a self-esteem perspective though depending on the amount of fluid being passed, disposable diapers can also be positive as they can hold more liquid and may eliminate leakage. Either can lead to skin irritation and sores if the urine is left in contact with the skin. The possible effectiveness of treatments such as timed voiding, pelvic muscle exercises, and electrical stimulation should be discussed with a doctor.
Kneading the perineum immediately after urination can help expel unvoided urine retained by a urethral stricture, a urethral sphincter that is slow to close, or overdeveloped abdominal floor muscles and connective tissue (as may be developed by the stresses of bicycle seats.)
Hospitals often use some type of incontinence pad, a small but highly absobant sheet placed beneath the patient, to deal with incontinence or other unexpected discharges of bodily fluid. These pads are especially useful when it is not practical for the patient to wear a diaper.
There are also trials taking place in the UK at the moment using Botox. It has been tested with some success under general anaesthetic conditions, and is currently (February 2006) being tried under local anaesthetic. While it originally appears that it may be quite successful for women, it does not appear to be as successful for men. Botox works for around 6-9 months when the treatment has to be redone.