Female Incontinence Treatment: Where to Start

Due to the effects of factors such as childbirth and menopause, women are much more likely to suffer from incontinence than men. In fact, it has been estimated that 9.6 million women in the UK are affected by bladder problems.

It is important to remember however that incontinence isn't an inevitable result of ageing. The majority of women who suffer from incontinence can be helped or cured. When it comes to finding treatment, the best choice for you depends on the cause of your incontinence and your personal preferences.

Your options for treating incontinence include the following:

Lifestyle changes and practising pelvic floor exercises

Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. You can do Kegel exercises, also known as pelvic floor muscle training, at any time in the day. A case study conducted by Dr. Dawn Sandalcidi in 2016 followed a woman whose symptoms of stress urinary incontinence prevented her from enjoying everyday life. She was provided with a PeriCoach System and a coach to assist her in doing pelvic muscle exercises. In 3 months, she went from soaking through an adult diaper while running to being able to run 3 miles with no leaking and no pads.

How to do Kegel Exercises:

• Find the right muscles.You can stop urination in mid-stream to find your pelvic floor muscles. If you succeed, you've got the right muscles. Once you've identified your pelvic floor muscles you can do the exercises in any position, although you might find it easiest to do them lying down at first.

• Perfect your technique.Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

• Maintain your focus.Focus on tightening only your pelvic floor muscles to achieve maximum effect. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.

• Repeat three times a day.Aim for at least three sets of 10 repetitions a day.

The biggest lifestyle change that can rapidly improve your incontinence is changing your diet. If you have an overactive bladder, avoid eating spicy foods like Mexican dishes, Chinese cuisine, chilli peppers, chilli, and horseradish. Caffeine and alcohol are also huge culprits when it comes to an overactive bladder.

Behavioural training, such as bladder training and timed urination

Before training your bladder, your Doctor may tell you to maintain a diary to record the frequency and time gap of your urge to urinate. Bladder training can significantly help you to gain the control to wait until your bladder is full. As you start the bladder training programme, it can bring you effective results within a few weeks of the start of the programme. However, depending on the severity, it can also take a few months. If your bladder diary shows that you visit the toilet in every 2 to 3 hours, you must try and increase the time by 15 minutes for every visit and hold the urge to urinate until this becomes a routine.

Medicines

In many cases, behavioural treatment with behavioural methods such as bladder training, timed urination and Kegel exercises are tried before medicines. However, if other treatment methods are not successful, medications may be the ideal method of treatment for you.

The most commonly used medications for incontinence treatment are the following:

Duloxetine- Duloxetine is ideal for treating stress incontinence. Duloxetine can help to increase the muscle tone of the urethra, which can keep it closed. If your Doctor recommends taking Duloxetine, you are usually advised to take it by mouth twice a day.

Mirabegron- You are often offered mirabegron if antimuscarinics are unsuitable for you. This medication is particularly useful for treating urge incontinence.

Mirabegron causes the bladder muscle to relax, which helps the bladder fill up and store more urine. This medication is often taken by mouth once a day.

Antimuscarinics- A number of different antimuscarinic medications can be used to treat urge incontinence in particular. Popular antimuscarinic medications include oxybutynin, tolterodine and darifenacin.

These medications are usually taken by mouth two or three times a day, although an oxybutynin patch that you place on your skin twice a week is also available.

Medical Devices                     

If you have incredibly weak pelvic floor muscles, an inserted vaginal device may be useful in preventing any leaks. Pressure applied by the devices helps to reposition and support the urethra, leading to fewer leaks with minimal risks. There are different types of devices women can use which include:

Vaginal Pessaries                                              

A vaginal pessary is a rubber or silicone removable device that is worn inside the vagina. It is designed to add pelvic support where the kegel muscles are weak and pelvic organs have prolapsed or are in danger of prolapse. This method reduces incontinence symptoms by supporting the bladder or putting pressure on the urethra. The pessary will be fit by your Doctor to hold the pelvic organs in position without causing discomfort.

The benefit of using these products is that they are small and subtle, allowing you to enjoy your daily activities comfortably. Your healthcare provider can remove, check and replace them or teach you how to do this independently.

It is recommended that you do not wear the pessaries all the time, as they can irritate the urethra. This could lead to blood in the urine and urinary tract infections.

Catheters                                                                                

Catheters are particularly ideal for people who cannot fully empty their bladder. The device is a soft tube that is inserted into the urethra to drain the bladder. You have the choice of wearing catheters everytime you need to go to the bathroom or you can wear them constantly. It is important for your Doctor to firstly recommend the right size of catheter for you and teach you how to use it.

Urethral insert

A urethral insert is a device resembling a tampon that you can insert into the urethra to prevent urine leakage. When you need to urinate, you simply remove the insert.

Although often successful, urethral inserts are an unpopular form of incontinence treatment due to the discomfort and risk of infection that they cause. Craig Comiter, M.D, an associate professor of urology asserts, "there’s no popular urethral plug on the market".

Surgery

Surgery is often classed as the last resort when other methods of treatment do not work. If you have tried alternative methods and they have been unsuccessful, methods of surgery available to you are the following:

Sling Procedures

A vaginal sling procedure is a type of surgery that helps to keep your urethra closed. There are two different types of sling procedures; conventional slings and tension free slings. Tension-free slings require no stitches and rely on the body’s own ability to heal to hold the sling in place and support the urethra. Conventional slings, on the other hand, are a strip of your own tissue taken from the lower abdomen or thigh. The ends of the sling are stitched in place through an incision in the abdomen. During your sling procedure, your Doctor will use strips of synthetic mesh, your own tissue, or sometimes animal or donor tissue to create a sling. This is placed under the tube that carries urine from the bladder, or the area of thickened muscle where the bladder connects to the urethra.

Prior to having your surgery, it is vital to tell your Doctor about any medications you are taking. Medications that thin your blood, such as warfarin, aspirin and ibuprofen are medications that your Doctor may recommend you to stop taking. Studies have shown an 88 to 95 percent success rate in sling procedures.

Tape Procedures

Tape procedures are a particularly useful option for women with stress incontinence. During a tape procedure, a catheter is placed into your bladder in order to drain urine from your bladder. A small surgical cut is then made inside your vagina. A synthetic mesh tape is then passed through the cut inside the vagina and positioned under your urethra. One end of the tape is passed through one of the belly incisions, and the other end of the tape is passed through the other belly incision. The middle part of the tape supports the urethra, and the two ends are threaded through two incisions in either the tops of the inner thigh or the tummy. The doctor then adjusts the tightness of the tape to support your urethra, reducing the leaking of urine associated with stress incontinence. Tape procedures have a high success rate, with an estimated two in every three women not experiencing any leaking afterwards.

Urethral Bulking Surgery

Urethral bulking surgery is generally less invasive than other surgical treatments available for treating stress incontinence as it doesn't usually require any incisions. During the surgery, a bulking material can be injected into the muscle at the bladder outlet, helping it to stay closed when you are physically active. This also increases the size of the urethral walls.

Although less invasive, the procedure is generally less effective than the other options available. It is recorded that half of the women who have this treatment feel that they are cured of stress incontinence.

Posterior Tibial Nerve Stimulation

Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor. It's thought that stimulating the tibial nerve will affect these other nerves and help control bladder symptoms, such as the urge to pass urine.

During the procedure, a very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and your foot to move.

You may need 12 sessions of stimulation, each lasting around half an hour, one week apart.

Some studies have shown that this treatment can offer relief from overactive bladder syndrome and urge incontinence for some people, although there isn't enough evidence yet to recommend tibial nerve stimulation as a routine treatment.

Tibial nerve stimulation is only recommended in a few cases where urge incontinence hasn't improved with medication and you don't want to have botulinum toxin A injections or sacral nerve stimulation.

Colposuspension

During Colposuspension, an incision is made in your lower abdomen, lifting up the neck of your bladder and stitching it in this lifted position.

There are two different variations of this surgery. Open Colposuspension is carried out through a large incision. Laparoscopic Colposuspension, on the other hand, is where surgery is carried out through one or more small incisions.

It is important to be proactive and ensure you have incontinence products that are suited for you. You can shop our range of female incontinence products to search for an incontinence product for you.