As you may have already read, Urinary Incontinence is a condition when urine leaks out involuntarily and the person will have barely any control over it. This happens because of improper coordination between the muscles surrounding the bladder (that holds the urine) and the muscles surrounding/supporting the urethra (that expels the urine).
When you present to a good gynaecologist with urine leakage problem, he/she may probe you with several questions regarding your food habits, life style, frequency of urination, previous surgeries, medication being taken at that time etc. Depending on his/her diagnosis, one or multiple of the following treatment options may be chosen by the doctor.
Suggesting changes to your lifestyle
Your gynaecologist may advise you to change your diet and the amount of fluids that you may be taking in. You might be asked to reduce your caffeine and alcohol intake. Drinking water (or other liquids) before going to bed may not be a good idea, especially if you are suffering from Incontinence problem. You may have to take a note of what you are eating so that can give a clue if any of your foods is irritating your bladder.
Training the bladder
You may be asked to make a note of your timings when you visit toilet. You will need to make a note of how many times you are emptying your bladder. After few days, you will need to set a time at regular intervals to empty your bladder and then see if that helps reduce the incontinence problem. If there are positive changes with this procedure, you will need to continue the process of scheduled urination to train the bladder only to expel the urine at scheduled times.
Pelvic floor exercise
Kegel exercises – a popular and simple workout to train and strengthen your pelvic muscles. This is same for both and men. In this exercise you practice to strengthen and relax your pelvic muscles. As the muscles in the pelvis region gain strength, they will be able to effectively control the bladder and the urethra. Ask your doctor how to exercise properly or you can checkout the video here.
Kegels exercise can help with Stress Urinary Incontinence, OAB (Overactive Bladder) or Urgency Urinary Incontinence)
Along with lifestyle changes, your gynaecologist/urologist may put you on to medication to help you with your incontinence problem. You will need to understand the effects of the medicine along with what the possible side effects are for those medications. A good gynaecologist will explain to you before hand on what you can expect when you start taking those medicines.
Anticholinergic drugs are prescribed to treat OAB/UUI. They help by relaxing the bladder muscles. Some of the antichlonergic medicines include oxybutynin, tolterodine, solifenacin etc. Noted side effects of these medicines are dry mouth, constipation, blurred vision. Long term usage of these medicines is proven to cause confusion and dementia. Another medicine that has come newly into the market is Merbegron. This medicine doesn’t show any of the above listed side effects as it works little differently on relaxing the bladder muscles. Patients with high blood pressure must inform the doctor before hand.
Depending on the problem and your age, hormone therapy may be advised. Estrogen replacement therapy helps in strengthening the walls of the vagina, muscles around the urethra. The muscles in the pelvic region gets loosened with age, especially for women who have given multiple vaginal births when they were young.
Sling for women:
A simple out-patient procedure that usually doesn’t take more than 30 minutes. In this procedure local anesthesia is given and a small cut is made near the vagina. A soft permanent mesh is placed under the urethra to support the closing of urethra when stress/pressure is put on the abdomen area. (When coughing, sneezing, bending, lifting weights, jumping or running etc). You can quickly return to work in a few days post this surgery.
Another type of sling called the ‘pubovaginal sling’ is put around the neck of the bladder. The tissue used to make the sling can come from the abdominal wall or made from a donated tissue.
Sling for men:
The procedure is similar to that done to women. The cut is made between the scrotum and the rectum (perineum area) and a soft mesh tape is placed under the urethra to support the urethra and sphincter muscle. This tape pushes the urethra up and helps in closing and prevents leakage.
Permanent bulking agents are injected into the urethra to make the lining of the urethra thicker. This reduces the size of the urethral opening there by reducing the leakage. This is a kind of permanent procedure approved for women.
Bladder neck suspension:
Bladder neck suspension is also called Colposuspension. This is a more complicated (than sling) surgery where the abdomen is cut open and the neck of the bladder is sutured to the pubic bone inside the pelvis. This takes time to heal and to get back to work compared to sling. Check with your doctor if they provide laparoscopic surgery for the same.
Artificial Urinary Sphincter
This is a most common treatment for men suffering from Stress Urinary Incontinence. A device is placed around the urethra, it is called Artificial Urinary Sphincter (AUS). In normal condition, this device closes the urethra to prevent leakage of urine. When the person wants to empty his/her bladder, he/she should activate the pump that will push the urine out of the body.
Bladder Botox ® Treatment
In this treatment, Botox ® is induced into the bladder wall. This done using a cystoscope and a small camera through the urethra. Then Botox ® is released into the bladder using a needle attached to cystoscope. An expert urologist or gynaecologist has to perform the procedure so that the Botox ® spreads evenly across the bladder walls. This relaxes the pelvic muscles and there by reduces the urgency to empty the bladder. This is an out-patient procedure and done using local anesthesia. After a month, the effects start taking place and the treatment will last for 6 to 9 months. After that, the procedure has to be repeated.
Also called ‘Nerve Stimulation’, in this treatment procedure, electric pulses are given to the nerves that control the bladder. This stimulation tells the nerves between the bladder, urethra and brain to calm down and helps in improving the communication between them. There are two types of such stimulations available today:
a. Percutaneous Tibial Nerve Stimulation (PTNS)
b. Sacral Nerve Stimulation (SNS)
This is very rare surgery done to patients suffering from OAB. There are two main categories in this surgery.
Augmentation Cystoplasty: The ultimate aim of the surgery is to make the bladder bigger so that it can hold more urine at any point of time.
Urinary Diversion Surgery: This surgery is to reroute the flow of urine from the bladder to an external object to hold the urine.
When the bladder is unable to empty completely, urine starts dripping even after emptying due to the pressure from the bladder. This problem most often comes up because of a blockage at the bladder neck or the urethra. The block will be removed through a surgery so that the urine can be emptied completely and avoid dripping. Typically men with enlarged prostate and those with urethral structure problems experience Overflow incontinence.