Patient Information

Conservative Options for Incontinence

Incontinence affects quality of life and is rarely life threatening so it is important that all avenues of treatment be explored before resorting to surgery. A number of non surgical therapies, incontinence devices and drugs are available to help treat incontinence. Before embarking on any treatment patients should consider lifestyle choices that may help their situation:

Avoid foods that cause incontinence symptoms
Limit alcohol and caffeine consumption
Space drinks out through the day
Maintain an appropriate weight
Maintain general good health
Eat a healthy diet with adequate vitamins
Exercise regularly
Quit smoking

Nonsurgical Treatment for Stress Incontinence

Pelvic Floor Training

Kegel exercises strengthen the pelvic floor muscles to improve bladder control for people suffering from stress incontinence. Success of these exercises depends on their being done correctly and this usually involves supervision by an expert physiotherapist.

There are two types of Kegel exercise:

Quick contractions–rapidly tighten and relax the sphincter muscle
Slow contractions–contract the sphincter muscle and hold to a count of 3, gradually increasing to a count of 10

Exercises should be performed several times, every day. Whether the goal is to improve or to maintain bladder control, exercises must be done regularly over a period of 6 to 12 weeks to be effective. Exercises should not be performed while urinating, because urine could be retained. Dr Farnsworth is happy to organise a consultation with one of our expert local physiotherapists. Usually this is done after treatment on the NeoControl Chair

Vaginal Cones

Ceramic vaginal cones a placed in the vagina and muscles are contracted to stop them falling out. This can help women isolate the pubococcygeous muscles and the cones are held for 15 minutes twice daily, while walking or standing.

Biofeedback
Biofeedback is practiced with Kegel exercise to reinforce proper technique. Patients visualize and identify the pelvic floor and abdominal muscles that are contracted during exercise.

A simple instrument records small electrical signals that are produced when muscles contract. The signals are instantly converted into audio and/or visual signs that help patients gain greater control over urinary muscle activity. Weak muscles can be activated on demand, tense muscles can be relaxed, and muscle activity can be coordinated.

Biofeedback can be coordinated by any of our physiotherapists. A clinical psychologist Marek Jantos also treats patients with severe pelvic pain with biofeedback in our clinic.

Functional Electrical Stimulation
This treatment is used to retrain and strengthen weak urinary muscles and improve bladder control. Electrical stimulation of the pudendal nerve causes pelvic floor and urethral sphincter muscles to contract. A probe such as the PFX 2000 device is inserted into the vagina (when treating a woman) or the anus (when treating a man) and a current is passed through the probe at a level below the pain threshold, causing a contraction. The patient is instructed to squeeze the muscles when the current is on. After the contraction, the current is switched off for 5 to 10 seconds. Treatment sessions lasts approximately 20 to 30 minutes. Small personal electro-stimulators are available for rent or purchase.

NeoControl®
This therapy is beneficial for women with stress, urge, or mixed urinary incontinence caused by weak pelvic floor muscles. The treatment is delivered through pulsating magnetic fields in the seat of a chair designed by NeoTonus, Inc. Patients sit in the chair for 20 to 30 minutes, twice a week. The magnetic pulses are aimed at the pelvic floor muscles through the seat of the chair and the muscles contract and relax with each magnetic pulse, much like Kegel exercise. It takes about 8 weeks of therapy to achieve some degree of continence.

Click here for further information on NeoControl®

Medication

Patients suffering from stress incontinence may benefit from alpha-adrenergic agonists, which stimulate receptors that respond to norepinephrine, a hormone and neurotransmitter. These agents should be used with caution by patients with high blood pressure,overactive thyroid (hyperthyroidism), irregular heartbeat (arrhythymia), or heart pain caused by insufficient oxygen supply to the heart muscle (angina).

Pseudophedrine hydrochloride is also found in cough and cold preparations and antihistamines. Typical dosage is 15-30 mg, three times a day.

Ephedrine, epinephrine, and norepinephrine are alpha-adrenergic agonists that have many effects throughout the body and must be used with caution. Significant side effects include hypertension, tachycardia (rapid heart rate), and arrhythmia (irregular heartbeat).

Hormone replacement therapy (HRT) can restore the health of urethral tissues in postmenopausal women. HRT involves estrogen to heighten bladder outlet resistance by increasing blood flow, muscle tone, and nerve response in the urethra. Estrogen is given with progesterone to avoid the risk for endometrial cancer.

Nonsurgical Treatment of Urge Incontinence

Treatments most commonly used for urge urinary incontinence are biofeedback electrical stimulation, bladder training with timed voiding, and surgery.

Bladder Training with Timed Voiding
This treatment is used for urge and overflow incontinence. The patient keeps a voiding diary of all episodes of urination and leaking, and the physician analyzes the chart and identifies the pattern of urination. The patient uses this timetable to plan when to empty the bladder to avoid accidental leakage. In bladder training, biofeedback and Kegel exercise help the patient resist the sensation of urgency, postpone urination, and urinate according to the timetable.

Medication

Anticholinergic and alpha-1-adrenergic blocking agents have proven to be effective in some patients with urge incontinence. Anticholinergic agents relax smooth muscle tissue and have an antispasmodic effect on overactive bladder.

Anticholinergic Agents
Propantheline bromide (Pro-Banthine®) is prescribed to stop bladder muscle contractions (overactive bladder). Typical dosage is 7.5 to 30 mg taken without food three to five times per day.

Oxybutynin chloride (Ditropan®XL) relaxes bladder smooth muscle. It is prescribed to treat urge incontinence caused by overactive bladder.

The oxybutynin transdermal system (Oxytrol®) is a thin, flexible, clear patch that is applied to the skin of the abdomen or hip, twice weekly, to treat overactive bladder. This treatment delivers oxybutynin continuously through the skin into the bloodstream and relieves symptoms for up to 4 days.

Patients who have urinary or gastric retention, uncontrolled narrow-angle glaucoma, and those with hypersensitivity to oxybutynin should not use the oxybutynin transdermal system.

Tricyclic antidepressants (TCAs) have anticholinergic effects that reduce nighttime incontinence and help manage urge incontinence. TCAs include doxepin hydrochloride (Sinequan®), desipramine hydrochloride (Norpramin®), nortryptyline hydrochloride (Pamelor®), and imipramine pamoate (Tofranil-PM®). The usual dose of Tofranil is 10 to 25 mg taken one to three times per day for a total of 25 to 75 mg daily.

Side effects
Side effects associated with anticholinergics include the following:

Confusion
Constipation
Dizziness
Drowsiness
Dry mouth
Headache
Nausea
Nervousness
Rapid heart rate (tachycardia)
Urinary retention
Visual blurring

Muscarinic receptor antagonist
Tolterodine tartrate blocks nerve receptors that control bladder contraction and reduces urinary frequency and urgency in overactive bladder and urge incontinence. The typical dose is 2-4 mg, twice daily.

Patients who have an adverse reaction to the drug or who have the following conditions should not use this medication.