Treatment For Urinary Incontinence In Women
Luckily, there are a number of different treatment options for urinary incontinence in women. Some of the treatment options include lifestyle changes while more serious cases might call for surgery, but each person is different. To better understand whats going on in your body, your urologist will need to first get a proper diagnosis.
Following your diagnosis, you will work with your urologist to create a treatment plan thats tailored to your needs. Most often, your doctor will recommend starting first with lifestyle changes to try and manage your symptoms. Some of these changes include performing kegel exercises regularly, maintaining a healthy weight, quitting smoking, and cutting out caffeine or alcoholboth of which are bladder irritants. During this time, you will also learn how to train your bladder and your doctor will recommend cutting back on liquids prior to going to bed. If you want to avoid any accidents during this time, consider looking into protective underwear or womens urinary incontinence products that can help catch any leaks.
In addition to Kegels, there are additional pelvic muscle rehabilitation techniques that your doctor might recommend. Biofeedback can help you perfect your Kegels and then you can move on to vaginal weight training to take things a step further. Some doctors may also discuss pelvic floor electrical stimulation with you as an option.
Clinical Management Of Urinary Incontinence In Women
This is a corrected version of the article that appeared in print.
LAUREN HERSH, MD, and BROOKE SALZMAN, MD, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Am Fam Physician. 2013 May 1 87:634-640.
Patient information: A handout on this topic is available at .
Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide. 1 Estimations of prevalence range from 3 to 55 percent, depending on the definition and the population.2 Within nursing homes, 60 to 70 percent of patients experience the disorder.3 These estimates are thought to be conservative, because at least one-half of patients do not report incontinence to a physician.4
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Conservative therapies should be the first-line treatment for stress and urge urinary incontinence.
|Clinical recommendation||Evidence rating||References|
Pharmacologic interventions should be used as an adjunct to behavioral therapies for refractory urge incontinence.
Surgical therapy should be considered in women with stress incontinence that has not responded to less invasive treatment modalities.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Conservative therapies should be the first-line treatment for stress and urge urinary incontinence.
Classification of Urinary Incontinence in Women
When Should I See A Doctor About Incontinence
Its important to know that incontinence can be treated. Many people believe that its something that just goes along with aging and is an unavoidable issue. If you find that incontinence is disturbing your daily activities and causing you to miss out on things you typically enjoy, talk to your healthcare provider. There are a wide range of options to treat incontinence.
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Urinary Incontinence In Older Adults
Urinary incontinence means a person leaks urine by accident. While it may happen to anyone, urinary incontinence is more common in older people, especially women. Incontinence can often be cured or controlled. Talk to your healthcare provider about what you can do.
What happens in the body to cause bladder control problems? The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder dont work the way they should, urine can leak. Incontinence typically occurs if the muscles relax without warning.
How Do Procedures Pinpoint A Diagnosis
If the previous tests and exams dont point to a diagnosis, the patient could undergo one of these procedures:
Bladder ultrasound and post-void residual
After urination, an ultrasound wand is placed on the abdomen, creating a bladder scan to show if any urine remains in the bladder. This procedure usually takes around five to 10 minutes, and a catheter may also be placed into the bladder to drain and measure any urine left.
A catheter is inserted, through which dye is injected into the bladder. An X-ray is then taken while the patient urinates, highlighting the urinary tract system. X-rays of the kidney, ureter, and bladder will be taken so the urinary system is completely visible.
A catheter fills the bladder with water to measure the pressure in the bladder when its at rest, when its filling, and when it empties. This test looks at the anatomy of the urinary tract, the bladders functioning ability, and capacity of the bladder, as well as what sensation the patient feels.
The doctor views the patients bladder through a bladder scope, which acts like a telescope. It is used to check for capacity, tumors, stones, or cancer.
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Behavioral Therapy: The First Treatment For Urinary Incontinence In The Elderly
After a diagnosis is made, behavioral therapy is often the first urinary incontinence treatment for the elderly. This may involve:
Learning to delay urination
You can do this by gradually lengthening the time between bathroom trips. One can also practice double voiding, which is when a person urinates, waits for a few minutes, and then urinates again. This teaches the person to drain their bladder more thoroughly.
Scheduled bathroom visits
This is often effective for people with mobility issues or neurological disorders, even if this means someone else is in charge of taking you to the restroom.
Drugs Stopping Sudden Bladder Muscle Contractions
Six approved antimuscarinic drugs work because they block nerve signals regulating bladder muscle contractions the drugs help to relax the bladder muscle and to decrease urges to void. Several studies have shown that these drugs resolve urinary incontinence in one woman among every eight or nine treated . These drugs include:
- Darifenacin ,
However, these drugs, especially oxybutynin, may cause adverse effects which may include:
For oxybutynin, one out of every 16 women stopped using it because of intolerable side effects.
When researchers compared the benefits and harms across these six different antimuscarinic drugs, they found that although these drugs demonstrate similar benefits, the potential for adverse effects was not the same . Women should discuss with their doctor what adverse effects are the most troubling for them. They can then choose the medication with the least risk for those specific side effects.
Unfortunately, none of the clinical studies evaluated the long-term safety of these antimuscarinic drugs. All drugs were tested in older women . However, we do not know long-term safety of these drugs in real-life geriatric settings. Future research should look at long-term safety in older women who are also taking several medications because of other chronic diseases.
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What Dogs Are Most Likely To Have Urinary Incontinence
Middle-aged to older spayed female dogs are very prone to urinary incontinence, commonly caused by lower estrogen levels. The lower estrogen levels make many senior female dogs lose muscle tone in the urethra. Spayed female dogs might also experience urethral sphincter mechanism incompetence.
All dogs become more prone to incontinence as they grow older and move towards their senior years. First signs of incontinence usually appear during middle-age. Different dogs reach middle-age at different times. While bigger dogs are considered middle-aged as young as five years old, smaller dogs reach this stage of their life much later.
Also, some dog breeds are more prone to incontinence, including:
- Cocker spaniels
Causes of Incontinence in Older Dogs
Incontinence can happen to any dog, but the medical condition is more prevalent among older dogs. There are various reasons why a dog can become incontinent. Usually, dogs become incontinent when they are sick.
Older dogs can have less control over their bladder due to illnesses such as bladder infections, urinary tract infections or abnormalities, and so on. You must address the problem as soon as you notice it because if left untreated, incontinence can worsen. You know your dogs incontinence problem is worsening when it experiences more urine leaking or when the urine starts irritating your dogs skin.
Surgical Management Of Ui
Data on surgical management of UI among the frail elderly is scarce. Outcome measures are often confounded by comorbidities and postoperative complications among the elderly. Age related physiological changes like pelvic floor weakness and impaired bladder function also affect the success of surgical treatment. The elderly is at a higher risk of postop morbidity and mortality than the younger patients, and the elderly with dementia have a high risk of developing postop delirium. Recent recommendations by the American College of Surgeons and American Geriatric Society for preoperative assessment of the elderly patients include assessment of comorbidities with optimization, medication management, nutritional improvement, screening for frailty, cognitive impairment and function preoperatively .
For the elderly women with stress incontinence, options include injection of bulking agents at the proximal urethra, midurethral sling, colposuspension, transvaginal/retropubic/transobturator tension-free vaginal tape are all recognized surgical interventions for stress UI. They are effective for women well selected to enroll in large trials with good gain in quality of life, with a risk of postop complications like infection. However, the more frail, disabled elderly with cognitive impairment have not been well studied .
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Will I Have Incontinence For My Entire Life
Sometimes incontinence is a short-term issue that will go away once the cause ends. This is often the case when you have a condition like a urinary tract infection . Once treated, frequent urination and leakage problems caused by a UTI typically end. This is also true for some women who experience bladder control issues during pregnancy. For many, the issues end in the weeks after delivery. However, other causes of incontinence are long-term and related to conditions that are managed throughout your life. If you have a chronic condition like diabetes or multiple sclerosis, you may have incontinence for a long period of time. In those cases, its important to talk to your provider about the best ways to manage your incontinence so that it doesnt interfere with your life.
A note from Cleveland Clinic
It can be embarrassing to talk about bathroom habits with your healthcare provider. This embarrassment shouldnt stop you from treating incontinence, though. Often, your healthcare provider can help figure out the cause of your bladder control issue and help make it better. You dont need to deal with it alone. Talk to your healthcare provider about the best ways to treat incontinence so that you can lead a full and active life without worrying about leakage.
How A Health Professional Can Help
The first health professional that youre likely to talk to about incontinence is your primary care provider, but they may refer you to another physician or professional who can better help. Urologists and gynecologists are surgeons who see men and women for incontinence, and nurse continence advisors can run specialized interprofessional clinics.
Diagnosing the cause of incontinence
What your doctor will ask about: The treatment of incontinence depends on the cause of the symptoms, which your doctor will evaluate by asking questions, doing a physical examination, and probably order a few preliminary investigations.
Your doctor will review your personal medical history, especially any history of prostate surgery for men, and for women, the history of any pregnancies and number and types of births. Lifestyle issues like smoking, alcohol intake, caffeine consumption, exercise , and body weight are likely to come up.
A careful review of the patterns of incontinence will help to determine the cause of urine loss.
To review, three common patterns of urinary incontinence are:
- Stress: if you lose urine when doing certain activities,
- Overflow: you lose urine all the time in a dribble,
- Urge: feeling an urgent need to get to the toilet that you sometimes cant meet,
In older adults, its common for there to be a mixture of more than one pattern .
Your doctor will want to know:
The physical examination
Urinary Incontinence Causes And Symptoms
Aging itself does not cause urinary incontinence, but changes that occur with aging can increase the risk of developing urinary incontinence by interfering with a persons ability to control urination. For example, the maximum amount of urine that the bladder can hold decreases. The ability to postpone urination decreases. More urine remains in the bladder after urination , partly due to less effective squeezing of the bladder muscle. In postmenopausal women, the urinary sphincter does not hold back urine in the bladder as effectively, because the decrease in estrogen levels after menopause leads to shortening of the urethra and thinning and fragility of its lining. Also, urine flow through the urethra slows. In men, urine flow through the urethra may be impeded by an enlarged prostate gland, eventually leading to bladder enlargement.
Urinary incontinence has many possible causes. Some causes, such as a bladder infection, a broken hip, or delirium, can bring on incontinence suddenly and abruptly. Other causes, such as an enlarged prostate in men or dementia, gradually interfere with control of urination until incontinence results. Incontinence may resolve and never recur. Alternatively, it may persist, recurring sporadically or, in some cases, frequently.
Approach To Urinary Incontinence In The Elderly In Primary Care: A Mini Review
Sebahat G c k,1
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1Deparment of Family Medicine, University of Abant Izzet Baysal, Turkey2Department of Urology, University, University of Abant Izzet Baysal, Turkey
Correspondence: Sebahat Gucuk, Department of Family Medicine, University of Abant zzet Baysal, Turkey, Tel 09 505 674 81 92
Citation: Gücük S, Gücük A. Approach to urinary incontinence in the elderly in primary care: a mini review. MOJ Gerontol Ger. 2017 1:160-162. DOI: 10.15406/mojgg.2017.01.00032
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How Is Incontinence Diagnosed
Often, the diagnosis process for incontinence will start with a conversation with your healthcare provider about your medical history and bladder control issues. Your provider might ask you questions like:
- How often do you urinate?
- Do you leak urine between trips to the toilet, how often does this happen and how much urine do you leak each time?
- How long have you been experiencing incontinence?
These questions can help your provider figure out a pattern with your leakage, which often points to a specific type of incontinence. When your provider is asking about your medical history, its important to list all of your medications because some medications can cause incontinence. Your provider will also ask about any past pregnancies and the details around each delivery.
There are also several specific tests that your provider might do to diagnose incontinence, including:
While at home, your provider might recommend you keep track of any leakage in a journal for a few days. By writing down how often you experience incontinence issues over the span of a few days, your provider might be able to identify a pattern. This can really help in the diagnosis process. Make sure to write down how often you need to urinate, how much you are able to go each time, if you leak between trips to the bathroom and any activities you might be doing when you leak urine. Youll then bring this journal with you to your appointment and talk about it with your provider.
Treatment Options For Incontinence In Elderly According To A Place For Mom And National Institute Of Aging
- Behavioral therapy, which will often cure the incontinence
- Bladder training or Biofeedback where sensors are used to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be helpful when learning pelvic muscle exercises.
- Scheduled bathroom trips or Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.
- Pelvic muscle exercises work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer.
- Lifestyle changes may help with incontinence. You may benefit from: losing weight, quitting smoking, saying no to alcohol, drinking less caffeine , preventing constipation, and avoiding lifting heavy objects.
There are also medications that are available to help with incontinence in elderly, especially if the senior in question has a bladder, kidney or urinary tract infection. If an individual has diabetes, this should be discussed with your doctor, as it may actually make symptoms worse.
In closing, remember to share this post on social media and read more related articles.
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What Does The Incontinence Specialist Do
An incontinence specialist will reconfirm the history, examination, urinalysis, and treatment decision, as well as perform urodynamic studies. Although these studies do not actually simulate natural bladder filling precisely, they help to elucidate pathophysiology and to sort out the contribution of obstruction and neurological abnormality, which would point to entirely different treatments.
A specialist will also recommend medications or dosage changes and work closely with incontinence therapists in administering biofeedback and other techniques. Surgical treatments are available for prostatism, cystocele, prolapse, or tumors. Implantation of a prosthetic urethral sphincter, the injection of collagen or other materials to strengthen the urethra, and the implantation of sacral nerve stimulation devices may be recommended in appropriately chosen patients.