Urinary Incontinence Treatment
1 AnswerFor a percutaneous tibial nerve stimulation (PTNS) treatment, which lasts about half an hour, a hair-thin wire is inserted near the tibial nerve just above your ankle. The wire is connected to an external device that delivers low-frequency electrical pulses. The stimulation travels to the sacral nerve, where it is designed to reset nerve signals to the bladder and thus diminish incontinence related to an overactive bladder (frequent urination and urges to urinate). The treatment is used once a week for several weeks and then as needed to control symptoms.
1 AnswerIn the late 1990s, the FDA approved a pacemaker-like implanted device, InterStim, for use in men and women with bladder overactivity that has not responded to medication, bladder training, or biofeedback. In a 152-person multicenter trial without a control group, sacral neuromodulation significantly improved symptoms of severe urgency and frequency. This study, published in The Journal of Urology, showed that after five years, 58% of patients sustained at least a 50% reduction in leaking episodes, and 68% experienced at least a 50% improvement in heavy leaks. Forty percent of the patients with urgency and frequency problems reduced their number of voids by at least half, and 56% had a 50% or greater improvement in urgency symptoms.
On the other hand, this treatment is not without risks. About one-third of patients require repeat surgery because of pain, infection, or movement of the wire. InterStim is expensive, but Medicare and most insurers cover it.
Sacral neuromodulation is now FDA approved for fecal incontinence.
1 AnswerThere are several types of clinics that work with people with incontinence:
- Anorectal physiology labs. Run by clinicians and equipped to evaluate fecal incontinence (unintended passage of stool), these facilities are often located in hospital departments specializing in motility disorders or functional bowel disorders (most likely gastroenterology, surgery, or urogynecology departments) as well as in some private practices.
- Pelvic floor disorders centers. Some hospitals have developed clinics to provide one-stop shopping for the evaluation and treatment of many pelvic floor disorders, including urinary, fecal incontinence and pelvic organ prolapse. These clinics may combine the expertise of many specialists, including urogynecologists, colorectal surgeons, urologists, gastroenterologists, neurologists, physiatrists (physicians who deal with muscle and skeletal problems and rehabilitation), and physical therapists.
1 AnswerThere are several kinds of health professionals that work with people with incontinence.
- Urogynecologists. These are gynecologists who have taken additional training in problems affecting a woman's bladder, pelvic floor and pelvic organs -- including urinary and fecal incontinence (unintended passage of stool) or prolapse (a condition in which a part of the body drops from its normal position). Check your state's listing on the American Urogynecologic Society Web site. The specialty is also known as Female Pelvic Medicine and Reconstructive Surgery.
- Urologists. These medical doctors treat the urinary systems of both men and women as well as the male reproductive organs. The American Urological Association Web site has a physician locator.
- Gastroenterologists and colorectal surgeons. These doctors have training in treating conditions of the gastrointestinal tract, including fecal incontinence (unintended passage of stool). If you have diarrhea or digestive symptoms in addition to incontinence, start with a gastroenterologist, particularly if there is no known childbirth injury or other trauma to the. Several organizations offer physician locators.
- A colorectal surgeon should be prepared to offer you a range of surgical and nonsurgical options for treatment. The American Society of Colon and Rectal Surgeons has a directory of members.
- Biofeedback professionals. Health professionals who practice this technique include nurses and physical or occupational therapists. Look for someone with experience in bowel or bladder training. Start by asking the physician treating your incontinence, or contact the Biofeedback Certification Institute of America.
- Pelvic floor physical therapists. If you need help learning to strengthen and control your pelvic floor muscles and to use other behavioral strategies to maintain continence, a growing number of physical therapists specialize in this area and have undergone advanced training to earn a Certificate of Achievement of Pelvic Physical Therapy. Ask your physician for a referral, or contact the American Physical Therapy Association.
- Nurse specialists. If you are having skin problems related to incontinence or if you have not been able to find acceptable ways to manage your incontinence, a specialist in continence or ostomy (opening on the skin) nursing can offer practical advice. Contact the Wound, Ostomy, and Continence Nurses Society.
1 AnswerEstrogen is sometimes prescribed as an oral pill or vaginal supplement to improve the strength of tissues in the urinary tract of women who show signs of deficiency. However, in the large multicenter trial known as the Women's Health Initiative, oral conjugated equine estrogen (Premarin), both alone and combined with a progestin (as Prempro, the most commonly prescribed formulation), worsened stress incontinence (leaking when coughing or jumping) and overactive bladder (frequent urination and urges to urinate) in postmenopausal women who already had incontinence, and increased the risk that incontinence would develop in women who were continent at the beginning of the study. Few studies demonstrate any benefit of vaginal estrogen therapy in treating incontinence. But in one Italian study, women who received vaginal estrogen after a sling procedure developed fewer symptoms of overactive bladder after surgery than those who received no estrogen. Many surgeons prescribe topical estrogen to promote healing after surgery.
Hormone therapy is generally recommended only for the short-term treatment of menopausal symptoms. However, using vaginal estrogen cream or suppositories one to three times a week is probably safe over the long term because the estrogen does not enter the bloodstream in significant amounts.
1 AnswerAn antidiuretic hormone can be useful for men or women who are primarily troubled by the need to urinate during the night and produce more urine at night than during the daytime. Vasopressin, an antidiuretic hormone produced by the pituitary gland, signals the kidneys to reduce urine production while you sleep. The synthetic version, called desmopressin (DDAVP), works in the same way. If you have a medical condition that would be worsened by fluid retention (such as high blood pressure or congestive heart problems), your doctor is unlikely to prescribe antidiuretic hormone. Your electrolytes need to be carefully monitored when starting this medication, as it can cause dangerously low levels of sodium in your blood.
1 AnswerAn older category of antidepressant drugs known as tricyclic antidepressants can be useful for treating men and women whose primary complaint is that they wake up at night to urinate (a condition called nocturia). Drugs such as amitriptyline and imipramine combine both anticholinergic and alpha-adrenergic agonist actions. Low doses are sometimes prescribed either alone or in combination with anticholinergics to treat overactive bladder (frequent urination and urges to urinate).
Because they can cause drowsiness, these antidepressants can help people sleep through the night without getting up to urinate. Tricyclic antidepressants interact with a number of common medications, so your physician should be aware of all the medications you use (including over-the-counter or alternative remedies) before prescribing them. Antidepressants in the class known as the selective serotonin reuptake inhibitors (SSRIs), such as Prozac, are not effective in treating incontinence.
Duloxetine (Cymbalta) is an antidepressant that inhibits reuptake of both serotonin and norepinephrine. By altering the concentration of these neurotransmitters, the drug seems to increase the contraction of the urethral sphincter. However, this drug is not Food and Drug Administration (FDA)-approved for the treatment of incontinence, and it is not covered by most health insurance plans for the treatment of urinary incontinence.
1 AnswerAnthony Komaroff, MD, Internal Medicine, answeredAlpha-adrenergic antagonists are prescribed to men who develop overflow incontinence when an enlarged prostate interferes with normal urine flow. Also known as alpha blockers, these drugs have the opposite effect of alpha-adrenergic agonists -- they relax the smooth muscle of the urethra (the tube that connects the bladder to the outside of the body). They include doxazosin (Cardura), tamsulosin (Flomax), terazosin (Hytrin), and alfuzosin (Uroxatral).
1 AnswerOne method of rehabilitating a weakened pelvic floor in both men and women employs pulsed, focused magnetic fields generated by a patented device called NeoControl, available in some medical clinics. Pulsed magnetic energy causes the muscles to contract by stimulating the nerves that control them. This approach is the same as that has been used to keep muscles from atrophying while an athlete is in a cast.
For the treatment, you sit fully clothed on a special chair. During a 20- to 30-minute session, the chair sends pulsed magnetic fields to your pelvic floor. Your doctor will determine the optimal strength and frequency of the pulses. Treatments are painless, but you will feel your muscles contracting without any effort on your part. A typical treatment series involves 16 sessions spread over eight weeks. A urologist (a medical doctor who treats the urinary systems of both men and women) or urogynecologist (a gynecologist with special training and interest in incontinence) is most likely to have this device in his or her office.
1 AnswerHome biofeedback devices are handheld electronic devices that let you know how strongly you are contracting your pelvic muscles when you practice Kegels (exercises for the pelvic floor muscles). Muscle strength is detected with a vaginal sensor and displayed on the handheld component. Food and Drug Administration (FDA)-approved systems (such as Myself or the PFX Pelvic Floor Exerciser) are available without prescription. In other systems, you buy the vaginal probe and rent the biofeedback device by the month. The PFX device is available in a men's model that uses an anal probe.