Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Urinary Incontinence Treatment: More Exercise and Biofeedback
An individual should practice contracting the levator ani muscles immediately before and during situations when leakage may occur. This is known as the guarding reflex. Involuntary urine loss is stopped by tightening the urinary sphincter at the appropriate time (for example just as one is about to sneeze). By making this muscle squeeze a habit, one can develop a protective mechanism against stress and urge incontinence.
Success in reducing urinary incontinence has been reported to range from 56% to 95%. Pelvic floor exercises are effective, even after multiple anti-incontinence surgeries.
Vaginal weight training can be used to strengthen the pelvic floor muscles and treat stress incontinence in women. Vaginal weights look like tampons and are used to enhance pelvic floor muscle exercises. Shaped like a small cone, vaginal weights are available in a set of five, with increasing weights (for example, 20 g, 32.5 g, 45 g, 60 g, and 75 g). As part of a progressive resistive exercise program, a single weight is inserted into the vagina and held in place by tightening the muscles around the vagina for as long as 15 minutes. As the levator ani muscles become stronger, the exercise duration may be increased to 30 minutes.
This exercise is performed twice daily. With the weight in place, a woman can feel the appropriate muscles working so she knows that she is contracting the pelvic floor muscles. The contraction needed to keep the weight in place within the vagina increases the strength of the pelvic floor muscles.
The best results are achieved when standard pelvic muscle exercises (Kegel exercises) are performed with intravaginal weights. In premenopausal women with stress incontinence, the rate of cure or improvement is approximately 70% to 80% after four to six weeks of treatment. Vaginal weight training also may be useful for postmenopausal women with stress incontinence; however, vaginal weights are not effective in the treatment of pelvic organ prolapse.
Biofeedback therapy uses an electronic device to help individuals having difficulty identifying the levator ani muscles. Biofeedback therapy is recommended for treatment of stress incontinence, urge incontinence, and mixed incontinence. Biofeedback therapy uses a computer and electronic instruments to let an individual know when the pelvic muscles are contracting.
Biofeedback is intensive therapy, with weekly sessions performed in an office or a hospital by a trained professional, and it often is followed by pelvic floor muscle exercises at home. During biofeedback therapy, a special tampon-shaped sensor is inserted in the vagina or rectum and a second sensor is placed on the abdomen. These sensors detect electrical signals from the pelvic floor muscles. The patient will contract and relax the pelvic floor muscles when the specialist tells him or her to do so. The electric signals from the pelvic floor muscles are displayed on a computer screen.
With biofeedback, the patient knows that he or she is strengthening the pelvic muscles that need rehabilitation. The benefit of biofeedback therapy is that it provides minute-by-minute feedback on the quality and intensity of one's pelvic floor contraction.
Studies on biofeedback combined with pelvic floor exercises show a 54% to 87% improvement with incontinence. Biofeedback also has been used successfully in the treatment of men with urge incontinence and intermittent stress incontinence after prostate surgery.
Medical studies have demonstrated significant improvement in urinary incontinence in women with neurologic disease and in the older population when a combination of biofeedback and bladder training is used.
Female urinary incontinence is reduced more with biofeedback than with pelvic muscle exercises alone.