Medications For Overactive Bladder
Drugs used to treat OAB block the abnormal contractions of the bladder muscle and can therefore also help ease the symptoms of urge urinary incontinence in both men and women. Youll find a list of OAB medications available in Canada on page 20. Generally speaking, these drugs fall into three categories:
Anticholinergics
Anticholinergic medications block the action of acetylcholine, a chemical messenger that tells the muscles of the bladder wall to contract. Unfortunately, acetylcholine acts in other parts of the body as well, so medications that block it can cause unwanted side effects like dry mouth, blurred vision, impaired cognition and constipation. New extended or prolonged release versions of anticholinergic medications reduce the incidence of side effects and improve compliance because they only need to be taken once a day to produce a steady absorption rate and constant blood levels of the drug.
How To Do Them
Stand, sit or lie down with your knees slightly apart. Relax.
Find your pelvic muscle. Imagine that you are trying to hold back urine or a bowel movement. Squeeze the muscles you would use to do that. DO NOT tighten your stomach or buttocks.
Women: to make sure youve got the right muscle, insert your finger into your vagina while you do the exercise. You should feel a tightening around your finger.
Men: when you tighten the pelvic floor muscle, your penis will twitch and contract in towards your body.
- Tighten the muscles for 5 to 10 seconds. Make sure you keep breathing normally
- Now relax the muscles for about 10 seconds
- Repeat 1220 times, three to five times a day
Stick to it! You should begin to see results after a few weeks. Like any other muscle in your body, your pelvic muscles will only stay strong as long as you exercise them regularly.
If youre having a hard time doing Kegel exercises, your healthcare professional can teach you how to do them correctly. He/she may even suggest a tool or device to help make sure youre using the right muscles .
Your doctor may also suggest biofeedback, a training technique thats used to monitor the contraction of the pelvic floor muscles as you do your Kegel exercises. Biofeedback uses a machine that records the contractions of your muscles and translates the movement into a visual signal that you can watch on a monitor. Some people find this helpful in learning how to do Kegel exercises correctly.
Introducing Contrelleyour Everyday Bladder Support
Contrelle is a soft, gentle bladder support that comes with a reusable applicator. Its similar to a tampon so is easy to insert and remove, although works very differently.3
When correctly and comfortably in place, Contrelle is clinically proven to reduce the amount of bladder leakage caused by Stress Urinary Incontinence, putting you back in control of when you want to go to the toilet.1
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What Is Stress Urinary Incontinence
Stress urinary incontinence is a leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise. SUI is the most common type of urinary incontinence in women.
SUI can happen when pelvic tissues and muscles, which support the bladder and urethra, become weak and allow the bladder “neck” to descend during bursts of physical activity. This descent can prevent the urethra from working properly to control the flow of urine. SUI can also occur when the sphincter muscle that controls the urethra weakens. The weakened sphincter muscle is not able to stop the flow of urine under normal circumstances and when there is an increase in abdominal pressure. Weakness may occur from pregnancy, childbirth, aging, or prior pelvic surgery. Other risk factors for SUI include chronic coughing or straining, obesity and smoking.
It is important for you to consult with your health care provider for proper diagnosis of SUI.
Image Source: National Kidney and Urologic Diseases Information Clearinghouse
Meet Elitone Fda Medical Device For Stress Urinary Incontinence
I was thrilled when I learned that there was a comfortable, easy to use device that allows you o take control of this sensitive health issue in the comfort of your own home. This device doesnt require a prescription so you dont have to worry about an uncomfortable conversation/ // with your doctor about urinary incontinence. Elitone is the first FDA cleared medical device to relieve mild to moderate symptoms of urinary incontinence. Left untreated, urinary incontinence can become debilitating.
Before Elitone, most women relied on Kegals or other devices that have to be inserted into the vagina. Elitone was created to be worn under your clothes placed gently against the skin. Then the device works by applying low-intensity stimulation to your pelvic floor muscles. This device isnt inserted into the vagina and is non-evasive.
Elitone GelPads can be used 2 to 3 times if they are carefully placed back into the sealable pouch before they need to be replaced. Simply replace the gel pad if you notice that it isnt sticking to the skin properly or you no longer feel the same intensity of contractions during the previous session. About 50% of the women who have used Elitone reported that they had to shave for it to work properly.
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Pelvic Muscle Training Devices
You can use these products when you do Kegel exercises, which help strengthen and control the muscles you clench when you try to hold in urine. Although you don’t need external devices to do Kegels, you may find they help enhance your workout.
There are different kinds of Kegel training devices. Some are aimed at men and women, including appliances you squeeze between your thighs. Vaginal weights, rods, and cones of various sizes are intended for women.
Itâs hard to tell at a glance which items might help you — or how some of them work. So do research and talk to your doctor before you buy any of them. Your doctor can help you narrow down the choices.
A Urinary Incontinence Device To Prevent Bladder Leaks
In partnership with our friends at INNOVO
As a clinician and a researcher, Ruth Maher, DPT, PhD, has extensive experience with physical therapy for the pelvic floor to treat pain and incontinence and to support sexual health. One in three women experiences stress urinary incontinence , urine leaks caused by exertion or coughing. Exercises that strengthen the pelvic floor are an essential part of treatment however, Maher has found that many women are unable to contract the correct muscles. Often they are unaware that this is the case. Women would say they felt a contraction, but using ultrasound imaging, I could see that either there was no contraction of the pelvic floor muscles or other muscles, such as the glutes, were recruited, says Maher.
Maher saw the need for a therapy that could reliably stimulate contraction of the pelvic floor muscles to treat SUI, and she developed a prototype that delivered comfortable electrical stimulation through the skin rather than through the standard vaginal probe. This technology was the basis for INNOVO, a wearable device designed to quickly engage and strengthen pelvic floor muscles. INNOVO is FDA-cleared for the treatment of female stress urinary incontinence in the US. About womens reactions to the device, Maher says: They love it.
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What Questions Should I Ask My Surgeon If I Am Considering Surgery To Treat Stress Urinary Incontinence
Ask your surgeon about all SUI treatment options, including non-surgical options and surgical options that do and do not use mesh slings. It is important for you to understand why your surgeon may be recommending a particular treatment option to treat your SUI.
Any surgery for SUI may put you at risk for complications, including additional surgery. One complication that may occur when mesh slings are used is vaginal mesh erosion, which could require additional surgery to resolve.
If mesh erosion occurs through the vaginal tissue, it is possible that men may experience penile irritation and/or pain during sexual intercourse.
Ask your surgeon the following questions before you decide to have SUI surgery:
What Increases Your Risk
Sometimes several things combine to cause urinary incontinence. For example, a woman may have had multiple childbirths, be older, and have a severe cough because of chronic bronchitis or smoking. All of these might contribute to her incontinence problem.
Physical conditions that make urinary incontinence more likely include:
- Pregnancy and vaginal delivery.
Medicines and foods that may make urinary incontinence worse include:
- Caffeinated and carbonated drinks, such as coffee, tea, and soda pop.
- Alcohol drinks.
- Prescription medicines that increase urine production or relax the bladder .
- Smoking.
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Washable Pads And Pants
Although there is an initial out cost with washable incontinence products, they are more cost effective over time. Some people also prefer the absorbency of terry towels especially at night as it can contain quite a large volume. There is also less skin irritation involved. The downside is products designed for anything more than light leakage tend to be very bulky and not discreet.
- Washable Liners these are less commonly used than disposable liners as they tend to not be as effective. They are better suited to those who have control but want the reassurance of a pad
- Washable Pants these look exactly like everyday underwear but have an absorbent pad in the gusset area. Some women wear these in conjunction with a disposable pad for extra protection
- Washable All-In-Ones are usually made of terry towelling combine with a plastic pant to go over the top to avoid liquid seeping through. These are better for those with heavy bladder leakage. They are quite bulky though and folding and pinning the towelling into the correct shape can be quite fiddly
Otc Urethral Support Device Now Available To Treat Stress Urinary Incontinence
An over-the-counter device to treat stress urinary incontinence in women has been made available by Rinovum Womens Health.
The FDA-approved Revive device is designed to be inserted into the vaginal tract using a tampon-like applicator. By supporting the urethra and surrounding muscles, the device helps to temporarily reduce leaks associated with SUI. A looped retrieval string is used to remove the device the string must be discarded and replaced with a new string with each use.
Approval of the device was based on data from a single arm, clinical trial conducted in 73 female patients. Results showed that use of the device led to a clinically significant reduction in SUI symptoms in 71% of women SUI episodes were reduced to < 1 per day. In addition, 79% of patients reported no discomfort while wearing the device.
Revive can be worn up to 12 hours per day and can be reused for up to 31 days. The device is not intended for use in patients with urge incontinence.
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Mechanical Devices For Urinary Incontinence In Women
Urinary incontinence is involuntary loss of urine. The common types are stress and urge incontinence. Mechanical devices are made of plastic or other materials. They are placed within the urethra or vagina in order to stop or control the leakage of urine. This review of trials found that using mechanical devices might be better than no treatment but the evidence is weak. There was not enough evidence to recommend any specific type of device or to show whether mechanical devices are better than other forms of treatment such as pelvic floor muscle training.
The place of mechanical devices in the management of urinary incontinence remains in question. Currently there is little evidence from controlled trials on which to judge whether their use is better than no treatment and large well-conducted trials are required for clarification. There was also insufficient evidence in favour of one device over another and little evidence to compare mechanical devices with other forms of treatment.
Incontinence can have a devastating effect on the lives of sufferers with significant economic implications. Non-surgical treatments such as pelvic floor muscle training and the use of mechanical devices are usually the first line of management, particularly when a woman does not want surgery or when she is considered unfit for surgery. Mechanical devices are inexpensive and do not compromise future surgical treatment.
Follow Directions To Manage Safety Concerns
Like any item worn in the vagina, bladder supports come with a small but important risk of toxic shock syndrome .
They can typically be worn safely for up to eight hours within a 24-hour period.
As with any other tampon or device youd insert into the vagina, youd want to make sure that its removed as directed, says Dr. Vasavada.
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Noninvasive Electrical Stimulation For Stress Urinary Incontinence In Women
Review question
We investigated whether electrical stimulation was better than no treatment at all or better than other available treatments for curing or improving stress urinary incontinence symptoms in women. We also investigated whether SUI was cured or improved by adding electrical stimulation to other treatments, compared to other treatments and to different types of electrical stimulation. Finally, we investigated whether electrical stimulation represented value for money.
Background
About 25% to 45% of women worldwide have problems with leaking urine involuntarily. Women with SUI often leak urine with physical exertion such as coughing or sneezing. SUI can be treated with pelvic floor muscle exercises, vaginal cones, drug therapy or surgery, but there are various problems with these treatments. A possible alternative is electrical stimulation with nonimplanted devices, whereby an electrical current is delivered through vaginal electrodes.
How uptodate is this review?
We searched for studies that had been published up to 27 February 2017.
Study characteristics
We found 56 trials comparing electrical stimulation to no treatment or to any other available treatment.
Key results
We found that few women reported adverse effects with electrical stimulation, but there was not enough reliable evidence comparing electrical stimulation to other treatments to know more about its safety.
Quality of the evidence
A Good Alternative To Surgery
Bladder supports are often a good alternative to surgery. Theyre relatively comfortable and non-invasive, and you can wear them only when you need them.
A number of more active patients may use bladder supports because they just need something that will help when theyre being more physically active, says urologist Sandip Vasavada, MD.
Dr. Ferrando says theyre also a good option for women who simply want to avoid the possible risks or complications of surgery. So theyre not looking for surgery, they just want to manage it when theyre active, she says.
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Pads For Bladder Incontinence
Incontinence pads are probably the most common and well known type of product available. They are easily accessible either through your GP or from a retail store and are usually the first product tried by someone who has an issue with either bladder or bowel control.
There are many different combinations to try depending on your preference from thinner, more discreet pads through to disposable underwear. Incontinence pads are generally suitable for all. Some people can find them uncomfortable once they become soiled, it is important to change your pad as quick as possible after they become soiled to avoid sore, broken and irritated skin.
How Is Urinary Incontinence Diagnosed
Your doctor will ask about what and how much you drink. He or she will also ask how often and how much you urinate and leak. It may help to keep track of these things using a bladder diary for 3 or 4 days before you see your doctor.
Your doctor will examine you and may do some simple tests to look for the cause of your bladder control problem. If your doctor thinks it may be caused by more than one problem, you will likely have more tests.
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Other Types Of Incontinence
The main symptom of urinary incontinence is a problem controlling urination.
- Symptoms of stress incontinence:
- Involuntary release of urine, especially when you cough, sneeze, or laugh
- Leaking a small to moderate amount of urine
It is common for a woman to have symptoms of both types of incontinence. This is called mixed incontinence.
Criteria For Considering Studies For This Review
Types of studies
All randomised or quasirandomised controlled trials of mechanical devices in the management of adult female urinary incontinence.
Types of participants
All adult women with urinary incontinence diagnosed as having stress, urgency or other incontinence either by symptom classification or by urodynamic diagnosis, as defined by the trialists.
Types of interventions
Interventions using mechanical devices designed to control urinary leakage by being inserted:
-
within the vagina or
-
within the urethra or
-
applied to the external surface of the urethra.
Standard urethral catheters and simple collecting devices were excluded from the definition of ‘mechanical device’ because their main roles are diversion and hygienic collection of the urinary stream rather than to control incontinence. Vaginal cones and electrical stimulation devices were also excluded as they have been evaluated in separate Cochrane reviews .
Types of outcome measures
Purely clinical assessments were accepted since the value of these devices may be more obvious within a ‘lowtech’ community environment. The primary outcomes were improvement in patient symptoms, health status and quality of life.
Patient symptoms 3. Number requiring alternative management.4. Frequency of daytime micturition ).5. Frequency of nocturia .6. Incontinence episodes in 24 hours .7. Pad changes over 24 hours .
Objective clinical measures8. Formal pad weighing tests .9. Differences in the results of urodynamic tests .
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How Does The Leva Device Help With Incontinence
The leva device assesses the Kegels being carried out by the user through six internal accelerometers. The vagina is lifted by the surrounding muscles during pelvic floor exercises, and leva measures the incline of that lift using its six sensors. The change in incline can be seen on-screen in real-time by the user, allowing them to objectively assess their progress as they continually use the device.
While it can take months to see progress from pelvic floor exercises, a clinical trial of the first-generation leva device saw 50% of women experience symptom improvement within a week. By week six of the trial, 87% of women reported no urinary leakage at all.
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This study only included 23 women, but Renovia has recently completed a 350-participant strong trial, investigating how well the device holds up compared to a standard pelvic floor exercise routine. While the final study has yet to be published, Maus says it has yielded fabulous results.