Urge Incontinence Treatments
What are the treatment options for urge incontinence?
For urge incontinence there are also multiple treatment options available. The first step is behavior modifications including drinking less fluid, avoiding caffeine, alcohol and spicy foods, not drinking at bedtime, and timed voiding. Exercising the pelvic muscle (Kegel exercises) can also help. It is important to keep a log on the frequency of urination, number of accidents, the amount of fluid lost, the fluid intake and the number of pads used. This helps the urologist tailor treatment to your specific needs.
The mainstay of treatment for overactive bladder and urge incontinence is medication. This consists of use of bladder relaxants that prevent the bladder from contracting without the patient's intention. The most common side effect of the medication is dryness of the mouth, constipation or changes in vision. Sometimes, reduction of medication takes care of the side effects. Combinations of medications can also be used in some situations.
Other alternatives can be considered in patients who fail to respond to behavior modification and/or medication. A new and exciting technology is the use of a bladder pacemaker to control bladder function. This technology consists of a small electrode that is inserted in the patient's back close to the nerve that controls bladder function. The electrode is connected to a pulse generator and the electrical impulses stimulate the bladder nerves and control bladder function. The exact mechanism of action remains unknown.
Botox can also be used in refractory cases of urge incontinence. It is injected into the bladder muscle using a small needle and a cystoscope. It is however an off label use since it has not yet gained FDA approval for urgency incontinence. As a result the patient must pay out of pocket upwards of $1500 for the medication.
In more difficult cases, the bladder can be made bigger using a segment of small intestine. This operation, called augmentation cystoplasty, is very successful in curing incontinence but its main drawback is the need in 10 to 30 percent of the patients to perform self-catheterization to empty their bladder. It is extremely effective in curing bladder urgency and urge incontinence.
What can I expect after treatment?
The goal of any treatment for incontinence is to improve quality of life for the patient. In most cases, great improvements and even cure of the symptoms is possible. Treatments are usually effective, as long as the patient is careful with fluid intake and urinates regularly. Large weight gain and activities that promote abdominal and pelvic straining may cause problems with surgical repair over time. Using common sense and care will help ensure long-term benefit from these surgical procedures.
Because many of the incontinence treatments deal with implants and/or medical devices, adjustments and modifications may be required over time. Ask your doctor about typical follow-up procedures.
Information provided by the American Urological Association.