There are three main general strategies for treating urinary incontinence:
Behavioral Techniques
Your physician and healthcare team can teach you techniques to control your
own bladder and muscles of urination. These behavioral methods usually are
very simple and effective for specific types of urinary incontinence. The
most commonly used behavioral methods are pelvic floor exercise, biofeedback
and bladder training.
Kegels
Exercises to strengthen the pelvic floor muscles were originally described by
Kegel in 1948. Such exercises, which are now known as Kegel exercises, can
be used to regain bladder control, especially if the levator ani (pelvic
floor muscle) and/or sphincter muscles have been weakened by childbirth or
other factors.
To identify these muscles, you can perform a contraction (muscle squeeze) to
stop the flow of urine in midstream. If the urine flow stops, you've located
the correct muscles. The next step is to repeat the exercise frequently
throughout the day. Programs of 10 Kegels (for 30 seconds each) every hour,
or twice-daily Kegels (4 seconds each for 5 minutes) have proven effective.
The benefits of Kegel exercises are not immediate, so you should continue the
program for at least 8 to 12 weeks before expecting to experience any results. After you identify the muscles, Kegels should not be performed during voiding, since urine could be retained.
In women, weighted vaginal cones sometimes are used to help patients find the
proper muscles to squeeze during Kegel exercise. When the cone is held in
place, the exercise is being performed correctly. Weighted cones should be
worn for 15 minutes twice daily while walking or standing.
Kegel exercises improve the urethral support and closure mechanisms,
particularly during activities such as coughing or bending. Therefore,
Kegel exercises are notably helpful for stress incontinence due to the
effects of pregnancy in women or prostatectomy (prostate surgery) in men.
Biofeedback/Electrical Stimulation
Biofeedback is practiced to help people gain awareness and control of their
urinary tract muscles. The principle of biofeedback is simple: a variety of
instruments are used to record small electrical signals that are given off
when specific muscles are squeezed during contraction. These contraction-
related signals are instantly converted into audio and/or visual signs that
patients can recognize and learn from, in order to control muscular activity.
With biofeeback, weak muscles can be better activated on demand, overly tense
muscles can be relaxed, and overall muscle activity can be coordinated.
Biofeedback usually is performed in conjunction with Kegel exercises, since
it helps to reinforce correct Kegel techniques. Biofeedback lets patients
visualize and identify the pelvic floor and/or abdominal muscles that are
appropriate for their exercise programs.
Neuromuscular electrical stimulation (NMES) also is employed to "reeducate"
and strengthen weak urinary muscles. In NMES, electrical stimulation of the
pudendal nerve causes contraction of the pelvic floor and periurethral
(urethra-encircling) muscles. A probe is inserted into either the vagina
(female reproductive canal) or anus (outside opening of the large intestine),
and NMES is applied at an intensity that is below the threshold of pain.
Most NMES devices are biphasic: that is, they produce a current that
stimulates contraction, followed by a rest period of 5 to 10 seconds.
Patients are instructed to join in with the NMES-stimulated contraction.
Such assisted exercise eventually strengthens the pelvic floor muscles and
improves bladder control. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence. NMES treatment programs usually last
20 to 30 minutes. NMES devices are available for both home and hospital use.
Neocontrol Pelvic Floor Therapy System
The Neocontrol Pelvic Floor Therapy System is a pulsating magnetic chair designed by Neotonus, Inc. The Neocontrol system was recently approved by the Food and Drug Administration for the treatment of stress, urge, and mixed urinary incontinence due to pelvic floor weakness in women. The most common causes of pelvic floor weakness are childbirth, surgery, injury, or hormonal changes during menopause. With the Neocontrol system, patients relax fully clothed for 20-30 minutes twice a week in a chair that has magnetic technology embedded in the seat. Pulsating magnetic fields induce muscle contractions in the pelvic floor to build strength. Neocontrol treatment is painless. The treatment course takes about eight weeks or more. The technology produces highly focused pulsing magnetic fields. Patients sit in a chair for treatment which allows the therapeutic fields to be easily aimed at the muscles of the pelvic floor that control continence. These muscles contract and relax with each magnetic pulse, exercising them just as you would exercise any other muscle in our body, except your brain is not directing the contraction. "One way to think of NEOCONTROL is as an automatic
Kegel exercise machine." Fifty percent of clinical trial participants report being "completely dry" after eight weeks of therapy. More than 3/4 of clinical trial participants reported significant improvement in their continence.
Bladder Training/Timed Voiding
In timed voiding, the patient fills out a chart that notes all episodes of
urination and leaking. The physician then analyzes the chart and highlights
the patient's pattern of urination. Using this timetable, the patient can
plan to empty his or her bladder before experiencing accidental leakage.
In bladder training, methods of biofeedback and muscle conditioning are
used to alter the bladder's schedule for storing and passing urine. The
patient is taught to resist the sensation of urgency (the strong desire to
pass urine), to postpone urination and to urinate according to a timetable.
Bladder training and timed voiding are useful techniques for urge and
overflow incontinence.
