Incontinence | Non-Surgical Treatment of Incontinence

Incontinence | Non-Surgical Treatment of Incontinence

According to a report published in the peer-reviewed Journal of Urology (1), the prevalence of incontinence in males is as high as 18.9% in males and 37.7% in females. According to another report, published a few years later (in Journal of the American Geriatrics Society), it was estimated that the prevalence is as high as 2 to 55% in general population (2). Despite high prevalence of incontinence, a lot of patients do not seek medical intervention. This is mainly because a number of factors come into play when you have to take a decision regarding in continence treatment. Most important considerations are:

• Cost of incontinence therapy
• Optimal benefits and possible risk of side effects
• Prognosis or possible outcomes of therapy

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Non-Surgical Treatment Options For Incontinence:

Most commonly employed non-surgical treatment modalities for the management of incontinence are:

Pharmacological Options

There are several side effects or limitations of uncontrolled use of these drugs. It is highly recommended to follow the advice or prescription of your healthcare provider religiously. Most commonly advised pharmacological agents include:

• Duloxetine
• Topical estrogen (especially in elderly post-menopausal females)
• Oxybutynin
• Tolterodine
• Solifenacin

The efficacy of pharmacological therapy is often limited by allergic response to drugs, systemic complications, urinary retention and drug interactions.

Exercises:

In most cases, when the cause of incontinence is weakness of pelvic floor muscles (due to chronic cough, history of multiple vaginal births or advanced aging), pelvic floor strengthening exercises are most useful and effective. Most common variety is Kegal exercise that involves alternately contracting and relaxing pelvic floor muscles to regain strength. The benefits of pelvic floor muscle training can be enhanced by using biofeedback methods.

Medical Devices:

Stimulating pelvic floor muscles can help in achieving motor control over the sphincters. Magnetic stimulation and electric stimulation are two highly effective and popular interventions to regain continence.

Incontinence Products:

In elderly individuals or in patients with history of chronic conditions, use of incontinence products is highly effective for sanitary reasons and also to minimize the risk of urinary tract infections. A few examples include:

• Urinary catheters (a tube that connect your bladder with a disposable urinary bag). This method is known to cause incontinence in frail and weak patients and therefore should be employed after carefully weighing pros and cons.
• Hand-held urinals are also effective for immobile or elderly patients (to minimize the risk of accidents).
• Incontinence pads, underwear and adult pampers can be used in critical situations (outdoors or while exercising).

Lifestyle Modifications:

In addition, you can also benefit from lifestyle modification strategies such as:

• Taking frequent bathroom breaks or voiding at intervals instead of waiting for a strong urge to urinate.
• Wearing protective devices such as in continence brief or sanitary pads for hygiene reasons (especially in social gatherings to prevent embarrassment).
• Avoid diuretics or foods/beverages with diuretic action such as excessive tea, alcohol or caffeinated beverages (coffee , mocha, energy drinks).
• If you are overweight or obese, weight management can help significantly in improving the symptoms of in continence.
• Maintain regular exercise and healthy diet with all the in continence treatments to optimize results.

There are several surgical as well as nonsurgical modalities that can be employed to manage incontinence; if you think incontinence is interfering with your quality of life, seek immediate medical advice to manage your symptoms.
References:

1. Diokno, A. C., Brock, B. M., Brown, M. B., & Herzog, A. R. (1986). Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly. The Journal of urology, 136(5), 1022-1025.
2. Thom, D. (1998). Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. Journal of the American Geriatrics Society, 46(4), 473-480.
3. http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1030&pageaction=displayproduct