kidney and urinary tract disorders
Urinary Incontinence in Adults
Treatment of Urinary Incontinence
Treatment of specific causes Sometimes medications to treat certain types of incontinence General measures to reduce the inconvenience of incontinence The specific cause of incontinence can often be treated. There are also general measures that doctors may suggest to all people to reduce the inconvenience of incontinence. When amedication is causing a problem, doctors may be able to switch the person to a different medication or change the dosing schedule to provide relief (for example, a diuretic dose may be timed so that a bathroom is near when the medication takes effect). However, people should talk with their doctor before they stop taking a medication or change the amount or dosing schedule. Medicationsare often useful for some types of incontinence but should supplement rather than replace general measures. Medications include those that relax the bladder wall muscle and those that increase sphincter tone. Medications that relax the urinary sphincter may be used to treat outlet obstruction in men with urge or overflow incontinence. Regardless of the type and cause of incontinence, some general measures are usually helpful. Modifying fluid intake Bladder training Pelvic muscle exercises Fluid intakecan be limited at certain times (for example, before going out or 3 to 4 hours before bedtime). Doctors may suggest that people avoid fluids that irritate the bladder (such ascaffeine-containing fluids). However, people should drink 48 to 64 oz (1500 to 2000 mL) of fluid a day because concentrated urine irritates the bladder. Bladder trainingis a technique that involves having the person follow a fixed schedule for urination while awake. The doctor works with the person to establish a schedule of urinating every 2 to 3 hours and suppressing the urge to urinate at other times (for example, by relaxing and breathing deeply). As the person becomes better able to suppress the urge to urinate, the interval is gradually lengthened. A similar technique, called prompted voiding, can be used by people who care for a person with dementia or other cognitive problems. In this, the person is asked whether they need to urinate and whether they are wet or dry at specific intervals. ( Exercises ) are often effective, especially for stress incontinence. People must be certain to exercise the correct muscles, the muscles around the urethra and rectum that stop the flow of urine. The muscles are tightly squeezed for 1 to 2 seconds and then relaxed for about 10 seconds. The exercises are repeated about 10 times three times each day. People are gradually able to increase the time the muscles are tightly squeezed until the contraction is held for about 10 seconds each time. Because it can be difficult to learn to control the correct muscles, doctors may need to provide instruction or recommend the use of biofeedback or electrical stimulation (an electronic version of pelvic floor exercises in which an electric current is used to stimulate the correct muscles). The goal is to relax the bladder wall muscles. Bladder training, Kegel exercises, and relaxation techniques are tried first. Biofeedback also can be tried. With the urge to urinate, the person can try relaxing, standing in place or sitting down, or tightening the pelvic muscles. The most commonly used drugs areoxybutyninandtolterodine.Oxybutyninis available as a skin patch or skin gel as well as a pill. Newer medications includemirabegron,vibegron,fesoterodine,solifenacin,darifenacin, andtrospium. If other treatments are ineffective for urge incontinence, further treatments can be tried, such as gentle electrical stimulation of the sacral nerves by a device similar to a pacemaker, instillation of chemicals into the bladder (when the cause is a spinal cord or brain disorder), or, rarely, surgery. may be used for mixed stress and Urge incontinence or for either separately. For stress incontinence that is not relieved with medications and behavioral measures, surgery or devices such as pessaries may be helpful. The vaginal sling procedure creates a hammock of support to help prevent the urethra from opening during coughing, sneezing, or laughing. Most commonly, a sling is created from synthetic mesh. Mesh implants are effective, but a few people with mesh implants have serious complications. Alternatively, doctors can create a sling using tissue from the abdominal wall or leg. In men with stress incontinence, a mesh sling or an artificial urinary sphincter implant may be placed around the urethra to prevent leakage of urine. Treatment depends on whether the cause is bladder outlet obstruction, weak bladder wall muscles, or both. For overflow incontinence caused by bladder outlet obstruction, specific treatments may help relieve obstruction (for example, surgery or medications for prostate disease, surgery for cystocele, and dilation or stenting for urethral narrowing). For overflow incontinence caused by weak bladder wall muscles, treatments can include reducing the amount of urine in the bladder by intermittent insertion of a bladder catheter or, rarely, insertion of a catheter that remains in the bladder. The goal is to reduce the bladder's size, allowing its walls to regain some capacity to prevent it from overflowing. Other measures can help empty the bladder after urinating. These can include trying to urinate again after urination has ended (called double voiding), bearing down at the end of urination, and/or pressing over the lower abdomen at the end of urination. Occasionally, electrical stimulation can be used to help empty the bladder more completely. 