Am I At A Higher Risk Of Incontinence At An Older Age
Your body constantly changes throughout your life. As you age, the muscles that support your pelvic organs can weaken. This means that your bladder and urethra have less support often leading to urine leakage. Your risk for developing incontinence as you age might be higher if you have a chronic health condition, have given birth to children, went through menopause, have an enlarged prostate or have had prostate cancer surgery. Its important to talk to your healthcare provider over time about the risks of incontinence and ways you can manage it without interference to your daily life.
Treatments For Urinary Incontinence
Healthcare providers can help find the best treatment for urinary incontinence. There are many different options available such as:
Indwelling catheters
If you have urinary incontinence, your provider might prescribe a catheter A balloon holds the tube inside your bladder. The catheter drains urine out of the bladder into a bag outside the body.
Urine drainage bags
If you have urinary incontinence, your provider might prescribe a urine drainage bag to help collect urine coming out of the bladder. You can hide it under clothing and strap it to your leg. Your doctor can help you find a urine drainage bag thats the right size for you and feels comfortable to wear.
Catheters for intermittent catheterization
Your doctor may recommend a catheter that you dont have to wear all the time. Instead, you or your healthcare provider can insert and remove clean catheters 3 to 5 times a day. This helps decrease the chance of infection.
Absorbent products
Some providers may recommend that you use adult pads or adult diapers. These products help absorb urine leaking from the bladder, which helps protect your skin and clothes. You have the option of purchasing absorbent products that you throw away after each use, or you can purchase reusable products.
Toilet substitutes
Some people who experience urinary incontinence may have concerns about getting to a toilet in time. Toilet substitutes like commodes can provide convenience and peace of mind.
Medications For Urinary Incontinence
Other names: Bladder, Weak Incontinence Incontinence, Urge Urge Incontinence Weak Bladder
Incontinence is the inability to control the passage of urine. This can range from an occasional leakage of urine, to a complete inability to hold any urine.
The three main types of urinary incontinence are:
Stress incontinence — occurs during certain activities like coughing, sneezing, laughing, or exercise.
Stress incontinence is a bladder storage problem in which the strength of the muscles that help control urination is reduced. The sphincter is not able to prevent urine flow when there is increased pressure from the abdomen.
Stress incontinence may occur as a result of weakened pelvic muscles that support the bladder and urethra or because of a malfunction of the urethral sphincter.
Treatment for stress incontinence may include behavioral changes, medication, pelvic floor muscle training or surgery.
Urge incontinence — involves a strong, sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. You don’t have enough time between when you recognize the need to urinate and when you actually do urinate.
In most cases of urge incontinence, no specific cause can be identified.Although urge incontinence may occur in anyone at any age, it is more common in women and the elderly.
Treatment for urge incontinence may include medication, retraining, and surgery.
Mixed incontinence — contains components of both stress and urge incontinence.
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Urge Incontinence & Overactive Bladder
Urge incontinence, sometimes known as overactive bladder, is a sudden, strong need to urinate that is often accompanied by accidental leakage of large amounts of urine. Frequent urination, both day and night, is also a sign of urge incontinence.
Women with an overactive bladder may not experience leakage, but have such frequent need to urinate that it interrupts their daily life.
With urge incontinence, the muscles of the bladder spasm or contract, forcing urine past the sphincter muscles around the tube that urine flows out of . Pregnancy, childbirth, obesity, and urinary tract infections all increase a womanâs chance of developing urge incontinence. Urge incontinence is also common among the elderly.
Urge incontinence may have no known cause, or may occur due to nerve damage from other medical conditions like multiple sclerosis, Parkinsonâs disease, diabetes, or stroke. Spinal cord damage or bladder irritation can also be causes of urge incontinence.
Getting The Right Diagnosis
If youre experiencing urinary incontinence, dont hesitate to visit your doctor and explain your symptoms. Many types of doctors can diagnose urinary incontinence, including a primary care physician, OB/GYN or urologist. Urogynecologists have special training and expertise in womens incontinence issues.
Your doctor will take a detailed medical history and conduct a physical exam. This includes a detailed pelvic exam to assess the organs and muscles. Your doctor will also look for signs of underlying medical conditions that may be causing incontinence and perform any necessary diagnostic tests. You may be asked to keep a bladder diary to keep track of when you urinate and when you experience leakage. After the doctor has examined all the data, he or she will make a diagnosis and discuss potential treatments.
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Posterior Tibial Nerve Stimulation
Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor.
It’s thought that stimulating the tibial nerve will affect these other nerves and help control the urge to pee.
A very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and your foot to move.
You may need 12 sessions of stimulation, each lasting around 30 minutes, 1 week apart.
Some studies have shown that this treatment can offer relief from urge incontinence and overactive bladder syndrome for some people, although there’s not enough evidence yet to recommend tibial nerve stimulation as a routine treatment.
Tibial nerve stimulation is only recommended in a few cases where urge incontinence has not improved with medicine and you do not want to have botulinum toxin A injections or sacral nerve stimulation.
How Is Urinary Incontinence Treated
Depending on the cause and severity of urinary incontinence, both surgical and nonsurgical treatment options are available to patients.
First line treatments include muscle strengthening exercises, lifestyle changes, medication or a referral to a specialized pelvic floor physical therapist. Office procedures, such as injectable therapy or minimally invasive outpatient proceduresincluding suburethral slings and nerve stimulationare also available.
Patients who still suffer from bladder issues after multiple treatment options have failed might be eligible for a clinical trial, designed to test new, experimental treatments.
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What Should I Do After My Surgery To Treat Stress Urinary Incontinence
- Continue with annual check-ups and follow-up care, notifying your health care provider if complications develop, such as persistent vaginal bleeding or discharge, pelvic or groin pain, or pain during sexual intercourse. There is no need to take additional action if you are satisfied with your surgery and are not having complications or symptoms.
- If you have complications or other symptoms:
- Discuss complications and treatment options with your health care provider. Only your health care provider can give you personalized medical advice.
- Consider getting a second opinion from a surgeon who specializes in female pelvic reconstruction if you are not satisfied with your discussion with your health care provider.
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.
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Urinary Incontinence Treatment Options
There are multiple treatment options available for urinary incontinence – lifestyle changes, exercises, medications, medical devices, and surgeries. Every woman is different!
Lifestyle Changes: Depending on the cause and type of urinary incontinence, lifestyle changes can make a positive difference in managing symptoms. An active lifestyle with weight loss can decrease leakage in overweight women. Training our bladders to hold urine and managing the amount and types of fluids we drink can help prevent leakage. In addition learning the foods and toxins that trigger our symptoms can be a huge step in the right direction.
Exercises: Kegels are an exercise that is often recommended to treat stress incontinence. We contract the muscles in the pelvic floor to strengthen the bladder. The great news is there are no side effects, and this only takes a few minutes every day.
Medications: Medications that help the muscles and nerves of the bladder function properly are used to train urge incontinence. Oral medications that relax the nerves of the bladder may allow it to fill more completely and stop the feeling of uncontrollable irritation. Botox injections into the bladder can stop it from contracting inappropriately. Treatment with vaginal estrogen can rejuvenate the vaginal and urethral lining to prevent irritation and urinary tract infection.
There is no need to live with embarrassing and inconvenient leaks – schedule an appointment today so we can find the best fit for you!
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.
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What Are The Treatment Options For Women With Stress Urinary Incontinence
Women have both non-surgical and surgical options to treat SUI.
Not every woman with SUI will need surgery. Some factors you should consider before deciding whether to undergo surgery include:
- the severity of your SUI symptoms and their effect on your daily activities
- your desire for future pregnancy as vaginal delivery can cause recurrence of SUI symptoms, which could require future surgery
NONSURGICAL TREATMENT OPTIONS
Examples of nonsurgical treatment options for SUI include:
- Pelvic Floor Exercises: A type of exercise to strengthen the pelvic floor by contracting and relaxing the muscles that surround the opening of the urethra, vagina, and rectum. These exercises, commonly referred to as Kegel exercises, improve the muscles strength and function and may help to hold urine in the bladder longer.
- Pessary: A removable device that is inserted into the vagina against the vaginal wall and urethra to support the bladder neck. This helps reposition the urethra to reduce SUI.
- Transurethral Bulking Agents: Collagen injections around the urethra that make the space around the urethra thicker, thus helping to control urine leakage. The effects may not be permanent.
- Behavioral Modification: This includes avoiding activities that trigger episodes of leaking.
SURGICAL TREATMENT OPTIONS
Surgical mesh in the form of a “sling” is permanently implanted to support the urethra or bladder neck in order to correct SUI. This is commonly referred to as a “sling procedure.”
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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Sling Procedure For Women
The most common type of surgery to correct stress incontinence is a sling procedure. During this procedure, surgeons use body tissue, mesh or synthetic materials to create a sling or ribbon that acts as a hammock to support the urethra. The sling ensures the urethra remains closed during nonurinating actions like laughing, coughing, sneezing or lifting.
There are a few different types of sling procedures. The most common is a midurethral sling surgery. During a midurethral sling procedure, a surgeon will use a narrow piece of synthetic mesh placed under the urethra to support it and the neck of the bladder. There are three types of midurethral sling placements:
- The retropubic method, which is also referred to as tension-free vaginal tape .
- Transobturator, which is sometimes called transobturator tape .
- A single incision sling procedure, which is often referred to as a mini-sling.
During a TVT procedure the surgeon will make a small cut inside the patients vagina under her urethra and two smaller cuts above the pubic bone. These incisions are tiny, only big enough to fit a needle through. The surgeon then uses the needle to place the sling under the patients urethra, behind the pubic bone, using skin glue or stitches to close the cuts.
What Makes Yale Medicine’s Approach To Treating Female Incontinence Unique
Incontinence is a difficult subject for patients to talk about. Here at Yale Medicine, we know the best conversations start with listening. We guide you towards treatments that best match your goals and lifestyle.
We are experts in the latest non-surgical and surgical techniques, and we have an established Urogynecology fellowship program. “We are training the future urogynecologists and that makes us stay sharp,” Dr. Harmanli says. “Plus, at Yale, we are surrounded by other specialists such as urologists, gynecologists, and colorectal surgeons with whom we can coordinate your care.”
At Yale Medicine Urogynecology & Reconstructive Pelvic Surgery, you will work with not only doctors but physical therapists and our nurse practitioner Cherrilyn Richmond, who will coach you through pelvic floor exercises.
Furthermore, researchers, including those at Yale, are at the forefront of developing new innovative treatment modalities that in 20 years, Dr. Harmanli trusts that, “is going to fix most these problems.”
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Treatment Options Urinary Incontinence
There are many different ways of coping with urinary incontinence. Seek help if your symptoms bother you: consult your family doctor, general practitioner, or a urologist. It may be uncomfortable to discuss your condition with a doctor, but it is the most effective way to deal with your concerns.
Treatment for urinary incontinence depends on the type of incontinence, how severe it is, and what may cause it. There is no single solution to incontinence that works for everyone. Discuss with your doctor or specialist nurse which measures can help you. It is common to try different options to figure out which one works best for you.
Sometimes, conservative measures can significantly improve your condition and lead to a better quality of life. These measures include lifestyle changes, bladder training and pelvic floor muscle exercises. Other treatment options, such as medication and surgery, should be considered if conservative management is not effective.
The most used drugs to treat urinary incontinence are the antimuscarinic drugs and mirabegron. Both intent to ameliorate urgency urinary incontinence. In some cases, other drugs like desmopressin, duloxetin or vaginal oestrogens could be appropriate. Discuss with your doctor if some of these drugs can help you and which benefits and adverse effects you can expect with any of them.
Behavioral Changes As Effective Incontinence Treatments
Patients are encouraged to make several changes to their daily routine that will likely improve their incontinence symptoms including the following.
- Re-training their bladder by waiting to go to the bathroom for about 10 minutes after the urge presents. The patient then slowly increases the amount of time delay before urination, with the goal of urinating every 2-4 hours.
- Double voiding, which is urinating, waiting a minute or so, then trying to empty the bladder once more. This helps to more completely empty the bladder.
- Scheduling urination for preset times rather than waiting for the urge.
- Exercising pelvic floor muscles with Kegel exercises to strengthen muscles that control urination.
- Exercise and healthy eating, patients should try to maintain a healthy weight, exercise, drink fewer fluids, and restrict the intake of alcohol, caffeine and acidic foods.
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