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Treating Incontinence

Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage. Women of all ages can learn and practice these exercises, which are taught by a health care professional.

Most Kegel exercises do not require equipment. However, one technique involves the use of weighted cones. For this exercise, you stand and hold a cone-shaped object within your vagina. You then substitute cones of increasing weight to strengthen the muscles that help keep the urethra closed.

Electrical Stimulation
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.

Biofeedback uses measuring devices to help you become aware of your body's functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Timed Voiding or Bladder Training
Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Biofeedback and muscle conditioning—known as bladder training—can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.

Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally.

Some of these medications can produce harmful side effects if used for long periods. In particular, estrogen therapy has been associated with an increased risk for cancers of the breast and endometrium (lining of the uterus). Talk to your doctor about the risks and benefits of long-term use of medications.

A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.

Implants are substances injected into tissues around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. Collagen (a fibrous natural tissue from cows) and fat from the patient's body have been used. Implants can be injected by a doctor in about half an hour using local anesthesia.

Implants have a partial success rate. Injections must be repeated after a time because the body slowly eliminates the substances. Before you receive collagen, a doctor must perform a skin test to determine whether you would have an allergic reaction to the material.

Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success.

Most stress incontinence results from the bladder dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.

For severe cases of stress incontinence, the surgeon may secure the bladder with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage.

In rare cases, a surgeon implants an artificial sphincter, a doughnut-shaped sac that circles the urethra. A fluid fills and expands the sac, which squeezes the urethra closed. By pressing a valve implanted under the skin, you can cause the artificial sphincter to deflate. This removes pressure from the urethra, allowing urine from the bladder to pass.

If you are incontinent because your bladder never empties completely (overflow incontinence) or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. Catheters may be used once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use a long-term (or indwelling) catheter, you should watch for possible urinary tract infections.

Other Procedures
Many women manage urinary incontinence with pads that catch slight leakage during activities such as exercising. Also, you often can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.

Finally, many women who could be treated resort instead to wearing absorbent undergarments, or diapers, especially elderly women in nursing homes. This is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are an elderly woman, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding, pelvic muscle exercises, and electrical stimulation before resorting to absorbent pads or undergarments.

Us News & World Report posted the following article with content excerpted from the Johns Hopkins White Paper on Prostate Disorders. Because surgery or radiation therapy may irritate the urethra or bladder or damage the urinary sphincter muscles that contract to prevent urine from flowing out of the bladder, some degree of incontinence is common immediately after treatment.

A number of methods can be used to reduce incontinence:

• Lifestyle measures: Simple changes in behavior can be helpful. A high-calorie diet and lack of exercise can lead to obesity, which increases pressure on the bladder and exacerbates incontinence. Because constipation can also worsen symptoms, it is important to eat high-fiber foods, such as leafy green vegetables, fruits, whole grains, and legumes. Caffeine and alcohol consumption should be limited since they increase frequency of urination. If nighttime urination is a problem, avoid consuming liquids several hours before bedtime.

• Collagen injections: Collagen can be injected around the bladder neck to add bulk and provide increased resistance to urine flow during times of physical strain. However, repeat injections often are needed because collagen is a naturally occurring protein and is broken down by the body.

• Artificial sphincter implantation: In this procedure, a doughnut-shaped rubber cuff is implanted around the urethra. The cuff is filled with fluid and is connected by a thin tube to a bulb implanted in the scrotum. In turn, the bulb is connected to a reservoir within the abdomen. The fluid in the cuff creates pressure around the urethra to hold urine inside the bladder. When the urge to urinate is felt, squeezing the bulb transfers fluid from the cuff to the reservoir and deflates the cuff for three minutes so urine can drain through the urethra. Afterward, the cuff automatically refills with fluid and urine flow is again impeded.

• Penile clamps: These devices, which compress the penis to prevent urine from leaking, are an option for severe incontinence. Penile clamps are not recommended immediately after treatment because they prevent the development of muscle control that is needed to regain urinary continence.

• External collection devices: These condom-like devices can be pulled over the penis and held in place with adhesive, Velcro straps, or elastic bands. A tube drains fluid from the device to a bag secured on the leg. Often used with a penile clamp, these devices should not be used immediately after surgery, because muscle control needed for bladder control will not develop.

• Catheters: A Foley catheter is a small tube that is inserted through the urethra and allows urine to flow continuously from the bladder into a bag after prostate treatment. This option is not recommended for long-term use because it can cause irritation, infection, and, possibly, lack of muscle control.

• Medications: Medication can be used to control mild to moderate incontinence but is not effective for severe cases. Medication such as oxybutynin (Ditropan), tolterodine (Detrol), and propantheline (Pro-Banthine) may reduce urge incontinence by decreasing involuntary bladder contractions. Nasal decongestants, like pseudoephedrine, or the antidepressant imipramine (Tofranil) can reduce stress incontinence by increasing muscle tone in the bladder neck. Because pseudoephedrine is a stimulant that can increase heart rate and blood pressure, it should be used only under a doctor's supervision. The drug also may cause nervousness, restlessness, and insomnia and may have adverse effects in people with asthma or cardiovascular disease.

• Absorbent products: Wearing absorbent pads or undergarments is the most common way to manage incontinence. Typically used right after surgery, these products are effective for minor to severe incontinence.

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