Best Ways To Get Rid Of Urinary Incontinence

Urinary incontinence (UI) is any involuntary leakage of urine. It's a common and distressing problem that may have a profound impact on your quality of life. Urinary incontinence almost always results from an underlying treatable medical condition. For instance, continence and micturition involve a balance between urethral closure and detrusor muscle activity. Normal voiding is the result of changes in both of these pressure factors—urethral pressure falls and bladder pressure rises. Although urinary incontinence affects millions of people, it isn't a normal part of aging or, in women, an inevitable consequence of childbirth or changes after menopause. It's a medical condition with many possible causes, some relatively simple and self-limited and others more complex.

Treatment of Urinary Incontinence

Treatment options for urinary incontinence fall into four broad categories—behavioral techniques, medications, devices and surgery. In most cases, your doctor will suggest the least invasive treatments first, so you'll try behavioral techniques first and move on to other options only if these techniques fail. The success of your treatment depends most of all on the right diagnosis. Talk to your doctor about the specifics and possible complications of any treatment. Ask questions and express concerns to help find out which treatment is right for you.

Behavioral techniques

Behavioral techniques and lifestyle changes work well for certain types of urinary incontinence. They may be the only treatment you need.

Pelvic floor muscle exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles—the muscles that help control urination. Your doctor may recommend that you do these exercises frequently to treat your incontinence. They're especially effective for stress incontinence, but may also help urge incontinence.

To do pelvic floor muscle exercises (Kegels), imagine that you're trying to stop your urine flow. Squeeze the muscles you would use and hold for a count of three. Relax, count to three again, then repeat. You can do these exercises almost anywhere—while you're driving, watching television or sitting at your desk at work.

Bladder training. Your doctor may recommend bladder training—alone or in combination with other therapies—to control urge and other types of incontinence. Bladder training involves learning to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. Then try increasing the waiting period to 20 minutes. The goal is to lengthen the time between trips to the toilet until you're urinating every two to four hours.Bladder training may also involve double voiding—urinating, then waiting a few minutes and trying again. This exercise can help you learn to empty your bladder more completely to avoid overflow incontinence. In addition, bladder training may involve learning to control urges to urinate. When you feel the urge to urinate, you're instructed to relax—breathe slowly and deeply—or to distract yourself with an activity.
Scheduled toilet trips. This means timed urination—going to the toilet according to the clock rather than waiting for the need to go. Following this technique, you go to the toilet on a routine, planned basis—usually every two to four hours.
Fluid and diet management. In some cases, you can simply modify your daily habits to regain control of your bladder. You may need to cut back on or avoid alcohol or caffeine, if either causes you incontinence. If acidic foods irritate your bladder, cutting back on such triggers may rid you of your problem. For some people, reducing liquid consumption before bedtime is all that's needed. Losing weight also may eliminate the problem.

Medications

Many times, urinary incontinence can be corrected with the help of medication. Often, medications are used in conjunction with behavioral techniques. Drugs commonly used to treat incontinence include:

Anticholinergic (antispasmodic) drugs. These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Examples include tolterodine (Detrol), oxybutynin (Ditropan), solifenacin (Vesicare) and darifenacin (Enablex). These drugs can be effective at controlling incontinence, but a side effect is dry mouth.

To combat dry mouth, you may be tempted to drink more water, but that may not help your incontinence. Your doctor may recommend that you suck on a piece of candy or chew gum instead to produce more saliva. Or you may want to try an extended-release form of oxybutynin (Ditropan XL) or tolterodine (Detrol LA) or an oxybutynin skin patch (Oxytrol). These forms of medication may have fewer side effects than the standard forms do.

Imipramine (Tofranil). This antidepressant may occasionally be used in combination with other medications to treat incontinence. It causes the bladder muscle to relax, while causing the smooth muscles at the bladder neck to contract.
Antibiotics. If your incontinence is due to a urinary tract infection or an inflamed prostate gland (prostatitis), your doctor can successfully treat the problem with antibiotics.

Medical devices

Several medical devices are available to help treat incontinence. They're designed specifically for women and include:

Urethral inserts. These are small, tampon-like disposable devices or plugs that a woman inserts into her urethra—the tube where urine exits the body—to prevent urine from leaking out. Urethral inserts aren't for everyday use. They work best for women who have predictable incontinence during certain activities, such as playing tennis. The device is inserted before the activity. Whenever the woman needs to urinate, she simply removes the device. Urethral inserts are available by prescription.
Pessary. Your doctor may prescribe a pessary—a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage. You need to regularly remove the device to clean it. You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.

Surgery

If other treatments aren't working, several surgical procedures have been developed to fix problems that cause urinary incontinence. In men, surgery may be necessary to remove the obstructive part of an enlarged prostate gland. If your bladder or uterus has slipped out of position, a surgeon can put it back in place with a variety of techniques. Rarely, surgery to treat urinary incontinence may involve enlarging the bladder or correcting a birth defect. Or surgery may be needed to bolster weakened urinary sphincter muscles.

Some of the more common procedures include:

Artificial urinary sphincter. This small device is particularly helpful for men who have weakened urinary sphincters from treatment of prostate cancer or an enlarged prostate gland, and it's used rarely in women with stress incontinence. Shaped like a doughnut, the device is implanted around the neck of your bladder. The fluid-filled ring keeps your urinary sphincter shut tight until you're ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to be released. This surgery is the most effective procedure for male incontinence. Complications include malfunction of the device—which means the surgery will need to be repeated—and infection, but both are uncommon.
Bulking material injections. Some women and men with stress incontinence benefit from urethral injections of bulking agents. This procedure involves injecting bulking materials—which may be cow-derived collagen, carbon particle beads or synthetic sugars—into the tissue surrounding the urethra or the skin next to the urinary sphincter. The injection tightens the seal of the sphincter by bulking up the surrounding tissue. The procedure is done with minimal anesthesia and typically takes about two to three minutes. It usually needs to be repeated after several months, because the effect can be lost over time. There is a risk of rejection or infection.
Sacral nerve stimulator. This small device acts on nerves that control bladder and pelvic floor contractions. The device, which resembles a pacemaker, is implanted under the skin in your abdomen. A wire from the device is connected to a sacral nerve—an important nerve in bladder control that runs from your lower spinal cord to your bladder. Through the wire, the device emits electrical pulses that stimulate the nerve and help control the bladder. The pulse doesn't cause pain and provides relief from heavy leaking in many cases. Possible complications include infection, but the device can be removed.

Absorbent pads and catheters

If medical treatments can't completely eliminate your incontinence—or if you need help until a treatment starts to take effect—you can try products that help ease the discomfort and inconvenience of leaking urine. These products should be a last resort, because most people benefit from other treatments.

Pads and protective garments. Various absorbent pads are available to help you manage urine loss. Most products are no more bulky than normal underwear, and you can wear them easily under everyday clothing. Men who have problems with dribbles of urine can use a drip collector—a small pocket of absorbent padding that's worn over the penis and held in place by close-fitting underwear.
Catheter. If you're incontinent because your bladder doesn't empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder (self-intermittent catheterization). This should give you more control of your leakage, especially if you have overflow incontinence. You'll be instructed on how to clean these catheters for safe reuse. In rare cases of extreme illness, people have to keep a catheter in constantly. The catheter is connected to an external bag to hold urine. As needed, the bag is emptied.

Treatment for urinary incontinence depends on the type of incontinence, the severity of your problem and the underlying cause. Your doctor will recommend the approaches best suited to your condition. Often a combination of treatments is used. Most people treated for urinary incontinence see a dramatic improvement in their symptoms.