Your Guide To Treating Incontinence

Your Guide To Treating Incontinence

For many of us, January is a time for setting resolutions – A blank slate where we can rewrite a new reality for ourselves. For those with incontinence, knowing where to start treatment can be one of the biggest challenges.  Luckily, we’re here to help.

Treatment for incontinence has come a long way in recent years.

Here’s a breakdown of steps you can take right now, as well as some more advanced options to look at for the future.

1. Manage incontinence with adult absorbent products.

Managing your incontinence is much different than treating your incontinence, but it is the logical first step. After all, you need to find some way to stay dry until you can properly address the issue. For most people, management will consist of a few things – finding a good absorbent product that works, and watching your food and drink intake to see if there are certain triggers that may make your incontinence worse. Management is a first step, but definitely not the last - while both of these can do wonders in helping you control the symptoms of incontinence, they’re not really addressing the true problem.

2. Behavioral Therapy

Along with diet and exercise, there are several other things you may want to try when treating incontinence. Bladder and bowel retraining – which literally involves training your muscles to hold urine or bowel movements for longer more controlled periods of time – are a good step to try and improvements can often be seen in several weeks.  In addition, many people see vast improvements from physical therapy. A qualified physical therapist (usually specialized in treating the pelvic floor) can give you an examination, pinpoint areas of weakness or tension, and provide a customized treatment plan designed to address your muscle strength or weakness. (Need help finding a PT? Check our Specialist Locator.)

3. Medications.

If behavioral modifications don’t yield the results your looking for, medications may be your next option. Most medications for bladder control work by relaxing the bladder muscles and preventing the spasms that sometimes accompany overactive bladder and incontinence. These work differently for everyone, and can sometimes produce unwanted side effects though, so talk to your doctor about your options before settling on one.

4. Advanced Therapy Options

If medications don’t work for you, or you don’t like the side effects that they present, there are still other options. InterStim and Botox injections are two of the more advanced, yet very effective procedures available.   InterStim, also known as sacral neuromodulation, works by stimulating the nerves that control your bladder, bowel and rectum, and the muscles related to urinary and anal functions (the sacral nerves). InterStim stimulates these nerves with a mild current, which helps your bladder/bowel/rectum work as they should.  Botox, treats overactive bladder symptoms by calming the nerves that trigger the overactive bladder muscle. Both procedures are fairly simple and take about an hour to complete.

5. Surgery.

For some, surgery may be an option. There are several types of surgeries that address stress urinary incontinence.  These procedures are intended to help correct a weakened pelvic floor, where the bladder neck and urethra have dropped. The most popular procedure is to use a sling, which serves as a “hammock” to support the urethra. Surgical slings may be used in both men and women who experience stress incontinence, and also women who have experienced pelvic organ prolapse. There are many types of sling procedures so be sure to talk to your doctor about your options and research what is right for you.

The most important thing to remember when exploring incontinence treatment is that you have options. Talk to your doctor about your wishes and work together to find a treatment that works for you.

What Causes Incontinence In Women?

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Incontinence is a condition that affects over 25 million men and women in America. It can really happen to anyone, and can be caused by many different things. But it is much more common in women – nearly twice as common actually – and unfortunately has become something that many people (even potentially your doctor) brush off as being a normal part of aging. This couldn’t be further from the truth.

Why Is Incontinence More Prevalent In Women?

Incontinence can have many root causes.  Being overweight, problems with the prostate in men, and even conditions that cause damage to the nerves, such as multiple sclerosis, Parkinson’s disease, or even diabetes can all lead to incontinence.  But it’s no secret that women suffer from incontinence more than men. This is in part due to the fact that things like pregnancy, childbirth, and menopause are unique to women and create extra pressure and complications that can cause incontinence. 

The pressure of carrying a baby for 9 months and the trauma of childbirth to the pelvic floor can weaken the pelvic floor, making it difficult to stay continent.  Additionally the hormonal changes that occur during menopause cause a change in continence.  A decrease in estrogen can cause the vaginal tissues to become less elastic and dry and can lead to incontinence and urinary tract infections.

What Types Of Incontinence Are There 

Did you know that there are actually different types of Incontinence? Depending on what you have, there may be different options available to you.

Urge Incontinence

Urge incontinence is the frequent and urgent need to use the bathroom, accompanied by bladder leakage.  You may have a sudden feeling that you have to go to the bathroom right now, or it may be triggered by familiar things, such as arriving home, washing the dishes, etc. This type of condition may also exist without bladder leakage, and is then referred to as Overactive Bladder. 

Stress Urinary Incontinence

Stress urinary incontinence happens when pressure is placed on the bladder and causes bladder leakage. This type of leakage might happen when you’re working out, or even when you sneeze or laugh. Unlike Urge incontinence, stress urinary incontinence is not typically accompanied by the sensation of a sudden urge to urinate. Rather, stress urinary incontinence is caused by a weakened pelvic floor, and/or a weak sphincter muscle.  Stress urinary incontinence often occurs in women (although men can have it too), and typically as a result of pregnancy and childbirth. It’s a condition that can get worse as you get older, since we lose pelvic muscle tone as we age. Luckily, there are many treatment options available, and behavioral modifications, such as learning how to create a healthy pelvic floor, can do wonders for this type of incontinence.

Mixed Incontinence

As the name implies, many women can suffer from both Stress Urinary Incontinence, and Urge Incontinence, although one is typically more severe than others. Treatment options for mixed incontinence are typically the same as the treatments you would use for stress urinary incontinence, or urge incontinence.

What Are My Options?

Luckily, there are many treatment options available for the various types of incontinence women tend to have.  Below are just a few treatment options available.

Behavioral Modifications.

Often, simple changes to our lifestyle, including changes to our diet and exercise regimen, can ease a lot of the symptoms of incontinence in women.  Learning the foods and drinks that irritate the bladder, and knowing how to strengthen the core and pelvic floor muscles can do a great deal to help reduce or even eliminate symptoms.

 Absorbents

Absorbent products come in all shapes and sizes and are a great option for those who need some extra protection. Read our guide to finding the right absorbent product for you.

 Medications

There are many types of medications available that can sooth an irritable bladder. These medications typically work by relaxing the muscles around the bladder, or stopping the signal to your bladder that you need to go right now!

Procedures

If medications and behavioral modification don’t work for you, there are several options that you may want to try before you think about surgery. Many women have seen success with botox injections into their bladder (it’s not just for wrinkles!), and different forms of neuromodulation, small pulses that stimulate the nerves involved in controlling the bladder.  Learn more about these options here.

Surgery

Finally surgery can be a good option for those who have tried other treatments without success. There are several types of surgical procedures, including urinary diversion, sling procedures, and augmentation cystoplasty, that can help with incontinence in women.

It’s important to note that no treatment is 100% effective all the type. Talk with your doctor about what you can expect with each treatment, as well as the pros and cons associated with them.

Urinary incontinence can have a big impact on a woman’s life and it’s important to get it treated.  Too many women live with symptoms of urinary incontinence, thinking it’s just a normal part of aging. But there are many treatments available and it can make life so much more enjoyable when you’re not looking for a bathroom or worried about having an accident. 

If you live with urinary incontinence, make an appointment with your doctor to talk about treatment options.  

Tips to keep incontinence from interfering with your sex life

Tips To Keep Incontinence From Interfering With Your Sex Life

If you struggle with incontinence and have concerns about leaking during sex, you're not alone. The American Foundation for Urologic Disease (AFUD) reports that one in three women with stress incontinence avoids sex due to fears of leaking during intercourse or orgasm. But incontinence during sex doesn't have to be an issue.  

Below are some tips to manage your incontinence and reclaim your sex life.

Be Prepared. 

Believe it or not, your behavior prior to sex can have a big impact on your chances of leaking during the act.  Here are a few tips to help you avoid an uncomfortable situation:

Avoid bladder irritating foods or drinks a couple of hours before bedtime.  

Not sure what your food and drink triggers are? There are some common ones, but you can also track your own habits for a week or so to determine what foods and drink you.

Limiting your fluids prior to having sex.

After all, the less you have in the bladder the less likely you may be to have a leak during sex.

Practice "double voiding" prior to sex.

This is when you go to the bathroom, wait a few minutes, and then go again to empty any residual urine that may still be present in the bladder.

Use protective bedding.

In case you do have an accident, at least your mattress will be protected.

Try a new position. 

You may find that a new position creates less stress on your bladder muscles, making leakage less likely. 

Strengthen up "down there".

Regular pelvic floor workouts can do wonders for women who experience incontinence. An added bonus?  Studies have shown that by strengthening your pelvic floor muscles you may also experience stronger orgasms and find sex more satisfying.

Talk about it with your partner. 

While this is an uncomfortable discussion to have, the mere act of telling your partner about your condition may relieve some of the stress associated with it. 

Talk to your Doctor.

If you've tried the steps above to no avail, consider talking to your doctor about your condition. Incontinence is not a normal part of aging and many things can be done to correct the situation. Your doctor can tell you about options that will best fit your needs.  Need help finding a physician?  Click here.

Struggling With Overactive Bladder? Know Your Options!

A Guest Blog By Dr. Harriette Scarpero, M.D.

It’s estimated that over 37 million Americans live with Overactive Bladder 1,2 – the urgent and frequent need to use the restroom. And yet, many people don’t receive the proper treatment they should. Part of this is due to one’s own embarrassment – no one likes to discuss the inability to control their bladder with anyone, even their doctor. In fact, in a recent NAFC survey of OAB patients, 74% said they waited longer than they should have to seek treatment3. And, while OAB has many treatment options, many of those people who didn’t seek treatment (26%) said they didn’t know about the treatment options available to them3. Sadly, of those who did seek treatment, only 20% were extremely satisfied with their current treatment3.

Wouldn’t it be nice if there were a roadmap for those living with OAB to know what their options are? Luckily, there is. It’s called a patient Care Pathway, and it helps you to know your treatment choices, usually ranging from conservative to more advanced treatments. A Care Pathway shows possible treatment options, and helps you make informed decisions. With OAB, a Care Pathway is a great tool for both patients and physicians to use to find a treatment that works and the patient is comfortable with. The new OAB Care Pathway, sponsored by Medtronic, does just that. This Care Pathway is based on the clinical guidelines for OAB from the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).

Here’s a quick breakdown of how to use a Care Pathway:

  1. Your first step is to speak with a physician about your symptoms. As with most treatments, starting with a conservative approach is best.
  2. Once your physician determines your condition, they may have you try various lifestyle changes such as improving diet and exercise, or working to strengthen your pelvic floor in addition to using protective absorbent products if leakage is a problem.
  3. If lifestyle changes don’t work, oral medications are a common next step. These medications can help, and are a mainstay of therapy when behavioral and lifestyle changes prove ineffective. Some patients do experience side effects with medications, which may be difficult to handle. In fact, studies have shown that many patients with OAB do not stay on medications long term – only 28% of patients remained on medications after 6 months in one study4. Unfortunately, all too many patients think this is their last option and many do not see a physician again. This is where a Care Pathway can really help a patient and physician who aren’t sure what to try next.
  4. Advanced therapies can play a big role in the treatment of OAB, and are a good option to explore if medications haven’t worked for you. Sacral Neuromodulation is thought to target the nerves that are responsible for bladder function. Additionally, injected medications (Botox) block the signals that trigger OAB by calming the nerves and bladder muscle. Both of these may be treatments your doctor discusses with you after trying oral medication.
  5. Finally, if advanced therapies don’t work, a patient can look to surgical procedures that may help.

More education around the treatment options available can help you not only in finding a new solution that you may not have known about, but may also help you to get to a better place faster. If you’re suffering from symptoms of Overactive Bladder, study the OAB Care Pathway below, print it out, and walk through it with your doctor.

About The Author:  Dr. Harriette Scarpero is a board certified fellowship trained urologist and nationally recognized expert in female pelvic health and reconstruction (FPM/RS). She specializes in the urologic care of women.Dr. Scarpero received her B.A. in English from the University of the South in 1989.  She graduated from Louisiana State University School of Medicine in New Orleans, LA and completed her General Surgery Internship and Urology Residency at LSU Medical Center. She served as Chief Resident at LSU/Ochsner from 1999-2001.Before joining Associated Urologists, she was Associate Professor of Urologic Surgery at Vanderbilt University School of Medicine and a member of the Vanderbilt Academy of Excellence in Teaching. There her practice addressed complex reoperative cases as well as general female urologic cases.  She has helped train students, residents and fellows in FPM/RS for eight years and considers educating women about their urologic health to be an important component of the patient care she provides.As an expert in her field, Dr. Scarpero is active on many national urologic boards. She is a past president of The Society of Women in Urology, on the executive committee of The Society of Urodynamics and Female Urology, and participates on several committees for The American Urologic Association.Dr. Scarpero has published extensively in the areas of incontinence, urodynamics, and pelvic reconstruction, and she has been an invited lecturer at specialty meetings around the country. 

1. Stewart WF, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003 May;20(6):327-336. 2. United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2010 Revision, CD-ROM Edition. 3. Leede Research, “Views on OAB: A Study for the National Association of Continence.” December 16, 2015. 4. Yeaw J, Benner J, Walt JG et al Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009:15(9): 724-736

With Incontinence Treatment, Educating Yourself Is Half The Battle

Millions of Americans experience some form of incontinence.  And, while this condition affects both genders, if you are a woman, you are more likely to suffer from incontinence than men due to things like pregnancy, childbirth, and menopause. 

There are several different types of incontinence you may experience:

  • Stress Urinary Incontinence:  SUI occurs when any extra pressure placed on your bladder or abdomen causes you to leak urine.  Things like sneezing, laughing, or certain exercise all may trigger SUI.   
  • Urge Incontinence: Also known as Overactive Bladder, Urge Incontinence is the sudden, frequent feeling that you need to use the restroom. 
  • Mixed Incontinence: Many people suffer from both Stress Urinary Incontinence and Urge Incontinence combined.
  • Urinary Retention: This type of incontinence occurs when you are unable to completely empty your bladder, leading to leaks. 

The good news is that all of these conditions are treatable.  And now, more than ever, there are countless options for treatment, so if you haven’t yet found something that works for you, try again!  Here are some popular treatment options:

  • Absorbent products: Probably one of the most widely used treatment options, absorbent products are a good first line treatment for those who experience leaks.  There are many different types and fit is very important, so expect to try out a few and see what works best for you. And whatever you do, don’t use sanitary pads in place of absorbent products specifically designed for leaks – the two are made of different materials and sanitary pads are not designed to hold urine, so leaks are likely to occur if you use them for that purpose.
  • Behavioral Therapy:  Before trying out medication or other procedures, you may want to tweak some of your behaviors to see if they have any effect.  Things like altering your diet to eliminate bladder-irritating foods, starting a physical therapy routine, or practicing bladder retraining can all have an effect on managing your symptoms.
  • Medications: There are a number of medications that may help you with bladder control.  Most medications work by calming the bladder and reducing the spasms that sometimes happen and cause leakage.  Talk with your doctor about the different types and learn what may work best for you.
  • Non-invasive procedures: If you’ve tried medications and have not seen results, or experienced unwanted side effects, you may want to give a non-invasive procedure a try.  InterStim, Botox, and PTNS are all simple procedures that can be administered in a urologist’s office and can have a significant effect on symptoms and quality of life.  Talk with your doctor to learn more about these procedures and what you can expect if you choose to go this route.
  • Surgery:  Several surgical options exist for those experiencing urinary incontinence.  Surgery is often a more permanent solution, and is a common approach for many who have failed on other treatment plans.  But, it’s not for everyone, and may not always eliminate all your symptoms.  Be sure to talk to your doctor (usually a urological surgeon) about what may work for you and what you can expect after surgery.

Finding the best treatment plan for you requires you to play an active role.  Know your options and educate yourself about the different treatments available so you are better able to discuss them with your physician and make an informed decision together. 

To find a specialist in your area, visit the NAFC Specialist Locator and make an appointment today!

Just Do It - Don't Wait To Start Treating Your Incontinence

Don't Wait To Start Treating Your Incontinence

Another year is almost over.  What have you done to overcome your incontinence this year?  Maybe you’ve started a new workout routine that strengthens the pelvic floor.  Maybe you’ve spoken with your doctor about a new medication to try.  Maybe you’ve even discussed taking a bigger step toward a permanent solution through surgery. 

Or, maybe you’ve done nothing.  Maybe you’ve continued to let incontinence control your life.  Maybe, for another year, you’ve declined social invitations for fear of having an accident.  Maybe you’ve kept your secret hidden from family members and loved ones because you are embarrassed.  Maybe you’ve spent another full year silently suffering.

Our question to you, then, would be this:  Why?  Why would you let your incontinence control you….your work….your family…..your life?  There are so many treatment options for incontinence that no one should have to suffer in silence.  Everyone deserves to live a full life ruled not by their embarrassments, shame and fear, but by their loves, interests and passions.

We get it – first steps are hard.  They require you to be brave, and open and honest.  They make you vulnerable.  They force you to trust-fall into life’s unknowns.  But trust us when we tell you:  they are so worth it.  

We challenge you this next year to take action.  Any action!  Open up to a friend about incontinence, talk to your doctor, go see a physical therapist – do something!  Because really, the alternative is no longer an option if you want to start living the life that you want. 

And, we have a sneaking suspicion that the moment you take that first step you will find that it wasn’t so difficult after all. 

Questions to ask your PT at your first appointment

Have you finally made that appointment with a PT to discuss incontinence issues? Kudos to you for seeking out physical therapy for your incontinence problems. As you prepare for your first visit questions may be circling through your mind. That is OK and is normal. Do not feel imitated by asking your physical therapist questions. 

Physical therapists love patients who are engaged and choose to participate in their treatment plan. A fully engaged patient will have better compliance resulting in an improved overall outcome. The end result may be a happier and healthier YOU!  

Carefully chosen questions will allow you to get to know your physical therapist and why they treat patients with your condition. No question truly is a bad question. So, let’s fire away. Below are some questions that should be on your list for your first appointment.

How long have you been practicing physical therapy?

Go ahead and ask - this question will provide a brief history of your therapist.  In order for your physical therapist to have obtained the skills necessary to properly evaluate and treat incontinence she will have been out of physical therapy school for a few years.  

What additional training have you received to evaluate and treat my condition?

It is ok to ask this question – this is your health and you want to be seen by a qualified provider.  Here is the reason why. The skill set necessary to treat incontinence is an advanced skill set that isn’t developed in physical therapy school. Your physical therapist will have taken at least one advanced course past physical therapy school in order to properly evaluate and treat pelvic floor conditions.

How long have you been seeing patients with my problem?

Asking this questions will establish your therapist’s experience with your condition.  Please do not be put off if you are one of her first patients.  Often times, when a therapist is ‘new’ to a condition – that patient is her primary focus and challenge.

What can I do outside of my physical therapy appointments to help in my treatment?

Ka-ching! Great question to ask.  Physical therapists love patients that want to work hard.  Your therapist will LOVE providing you practical and progressive home program to complement your clinic treatments.

Do you have or know of any resources that help me understand my condition?

Again, a great question. The therapist will likely have printed materials to give you but will also have recommendations for valid and reliable online resources.

About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.
About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.