Bladder Control Problems (cont.)

Medical Treatment

Treatment depends of the type and severity of the incontinence. Many of these treatments require a commitment on your part to master the technique and practice it daily. Discuss all of the treatment options with your health care provider before making a decision together.

Some medications that you may take for other medical conditions can cause incontinence. Review your medications with your health care provider. If a medication is causing the problem, an alternative may be available.

Urge incontinence: Treatment is focused on eradicating the underlying cause. If your health care provider is unable to identify a reversible cause, the focus of treatment becomes reducing symptoms. Treatment may include the following:

• Providing a commode or urinal for urination "emergencies"
  
  
• Limiting fluid intake
  
  
• Behavioral therapy - Changing your habits to try to reduce incontinence
  
  
• Timed voiding and bladder training regimens - Gradually prolonging the time between urination
  
  
• Pelvic floor exercises - To strengthen the sphincter muscles
  
  
• Pelvic floor electrical stimulation - Painless electrical pulses applied via a small probe in the vagina or rectum to increase tone of the pelvic floor muscles
  
  
• Medications - To relax the bladder or tighten the sphincter muscles

Stress incontinence: In general, surgical treatment is far more successful than nonsurgical treatment. Medications generally do not work well in stress incontinence. Nonsurgical methods cure very few people, although symptoms may improve for up to 88%.

• If overweight, work toward weight loss
  
  
• Kegel exercises
  
  
• Weighted vaginal cones - Strengthen pelvic muscles to prevent involuntary flow of urine
  
  
• Urethral plug - A small tamponlike insert placed into the urethra to block urine flow
  
  
• Topical estrogen cream - Applied in the vagina, for use only after menopause (Many people are reluctant to use estrogen cream because of its potential association with female malignancies. Topical estrogen, however, is a very good treatment for those who need replacement and the risk is negligible.)
  
  
• Pessary - A device worn by women in the vagina to help support the bladder and improve control
  
  
• Barrier devices - Work like pads but are much smaller and less bulky
  
  
• Pelvic floor electrical stimulation
  
  
• Medication - To increase the tone of the internal sphincter, not always effective

Overflow incontinence: No effective medication is available for this condition, which usually occurs in people with longstanding diabetes, bladder outlet obstruction, or lumbar spine injury/disease. The cornerstone of treatment is catheterization.

• A catheter is a thin tube that goes through your urethra to your bladder to drain urine. There are 2 different kinds of catheters.
  
  
  • One is an intermittent catheter. You insert this yourself whenever needed, drain your bladder, and remove the catheter. You are taught how to do this by a specially trained nurse.
    
    
  • The other, called a Foley catheter, is worn all the time. Urine drains into a bag, usually taped to your leg. You simply replace the bag as necessary. Your health care provider will make arrangements for you to have the catheter changed regularly. This type of catheter is used for incontinence only as a last resort.

No matter what type of incontinence you have, medical treatment can take some time to take effect. During treatment, or if medical treatment does not work for you, you have the following alternatives:

• Wear an absorbent product
  
  
• Use a catheter to remove urine
  
  
• Surgery

Next: Medications »

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