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Treatment

In addition to exercise/rehabilitation of the pelvic floor muscles, bladder retraining and dietary changes, there are also medications, urinary control devices and surgical procedures used to treat stress incontinence. While these treatments are usually used to treat more severe cases of incontinence, the strategies described in the Coping section can increase the effectiveness of these treatments.

Medications

If you have already tried more conservative measures – like modifying your diet, bladder training and doing exercises to strengthen your pelvic floor – but these are not solving the problem, your health-care provider may recommend medication to treat your urinary incontinence.

There are several drugs available to help control the symptoms of incontinence. You and your health-care professional should discuss which drugs are best for you, how to take the drugs, and any possible adverse effects. Any drug may have contra-indications and should not be used in certain circumstances. Discuss these with your health-care professional before you start taking a drug.

Medications for Overactive Bladder

Medications to treat overactive bladder are aimed at relaxing the involuntary contractions of the bladder and improving bladder function. Medications commonly used to treat overactive bladder include:

  • tolterodine tartrate (Detrol®)
  • oxybutynin chloride (Ditropan®)
  • solifenacin (Vesicare ®)
  • darifenacin (Enablex ®)

You may experience some unwanted side effects when taking these medications. If you do, see your health-care professional before stopping the medication. Side effects include:

  • dry mouth (most common)
  • heartburn
  • blurry vision
  • nausea
  • dizziness
  • drowsiness
  • increased heart rate
  • difficulty urinating
  • constipation
  • impaired memory and confusion

Medications for Stress Incontinence

Medications to treat stress incontinence are aimed at increasing the muscle tone in the sphincter, which holds urine in the bladder. Strengthening these muscles with Kegel exercises is very effective, but not always enough.

Antidepressants, such as imipramine (Tofranil®), are sometimes used to treat the symptoms of stress incontinence although such a drug is not effective in most cases and its side effects can be serious.

The female hormone estrogen, which can affect the muscles and tissues in the pelvis, has also been used to treat urinary incontinence. Some early studies found that estrogen can increase the tone and blood supply of the urethral sphincter muscles; however, more recent studies have found no benefit in using estrogen therapy to prevent or treat urinary incontinence. The Women’s Health Initiative, a large long-term health study in the US, found that hormone therapy, with estrogen alone or a combination of estrogen and progestin, can worsen the symptoms of urinary incontinence.

Medications for Overflow Incontinence

For overflow incontinence, which is caused by a weak or underactive bladder muscle, cholinergic agents, such as bethanechol (Duvoid®, Urecholine®), may be prescribed.

Common side effects from cholinergic agents include:

  • blurred vision
  • dizziness
  • nausea
  • diarrhea

Urinary Control Devices

A urinary device such as a pessary can help you control your incontinence. A pessary is a device that is inserted into the vagina to support the prolapsed uterus or bladder. It can also be used for symptoms of stress urinary incontinence.

Pessaries are made from silicone or other plastics. They often look like a diaphragm and come in a variety of shapes and sizes. A pessary must be fitted by a health-care professional. Once fitted, you can remove and insert the device yourself. The same pessary can often be used for several years if it is cared for properly.

Many types of pessary are designed to remain in the vagina during intercourse. Remember to ask your doctor about this. If a pessary is causing you discomfort, you should visit your doctor. Also speak to your doctor if you experience any discharge with or without odor. Note that this device may not be covered by your provincial health plan.

Surgery

You may find that you cannot control your bladder problems with exercises, bladder retraining or medication. If your symptoms are severe and interfere with your life, and more conservative measures have not worked for you, surgery may be an option. The goal of surgery is to cure the cause of stress incontinence by supporting the bladder and urethra in their proper position.

Several procedures can be used to achieve these goals. Three of the most common procedures are the Burch procedure, the sling procedure and the tension-free transvaginal tape.

The Burch Procedure

The Burch procedure is used when the bladder and urethra have fallen out of their normal position. The goal is to restore them to their normal position in the pelvis.

During the Burch procedure, the surgeon lifts the wall of the vagina where the urethra is located. The vaginal wall is sutured to ligaments near the pubic bone. This corrects the position of the bladder neck so that the bladder remains stable when you are coughing, sneezing or engaging in physical activities.

The Burch is usually performed by using a laparoscope, a special telescope-like instrument that can operate through small incisions. It can also be done as an open abdominal procedure. Open abdominal surgery requires an incision 3- to 5-inches long in the bikini area. This surgery requires about three days in the hospital and four to six weeks of recovery time.

When performed using a laparoscope, three or four quarter-inch incisions are made in the belly button and groin area. One of the main advantages of this procedure is a quick recovery time because the smaller incisions require less time to heal. Women also experience less pain and discomfort following the surgery. However, laparoscopic surgery requires the surgeon to have special training and skills. Most women can leave the hospital within 24 hours and many can return to their normal activities within three to six weeks.

The Burch procedure cures the urinary incontinence of a majority of women.

The Sling Procedure

The sling procedure is often used for women with severe stress incontinence caused by weak sphincter muscles, women who have had previous bladder surgery that failed, or women who have had a hysterectomy. In this operation, a sling is placed at the bladder neck, like a hammock, to support the bladder neck and prevent urine from leaking.

Studies have found that the sling procedure is successful in 80 to 90 percent of cases.

Tension-Free Transvaginal Tape (TVT)

This procedure, developed in 1995, uses a nylon mesh-like tape that is surgically inserted through the vagina to support the urethra. After a few weeks, tissue begins to form around the tape, holding it in place. The TVT works by compressing the urethra closed during movements that increase abdominal pressure, such as coughing or running. However, unlike the sling procedure, no sutures are needed and the procedure can be done as day surgery using local anesthetic and intravenous sedation.

TVT appears to be successful in about 85 percent of cases and reduces symptoms for an additional five to seven percent of women.

 

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Urinary Incontinence

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