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Taking Charge of Urinary Incontinence

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By Anna Spoelhof, FNP

Laurie Birkholz, MD, and Associates 

So, how do you take charge of urinary incontinence?

  1. First, talk to a healthcare provider: There are many medical factors that can cause or worsen incontinence, such as certain medications, a UTI, constipation, obesity, pelvic floor prolapse, or even menopausal changes.
  2. Watch your fluid intake: Try to limit bladder irritant beverages such as alcohol, black tea, & soda. You don’t need to eliminate these beverages completely, just see if it’s a trigger for you! Interestingly, recent studies have shown that caffeine reduction does not make a difference.
  3. Bladder Habit Retraining: Keeping track of a voiding diary can be useful when discussing symptoms with your healthcare provider or physical therapist. Physical therapists often do a wonderful job of offering this education.
  4.  Kegel Exercises/Pelvic floor PT: After a vaginal birth you may experience a weak pelvic floor (hypotonic pelvic floor) that can cause urinary leakage. You may be able to perform Kegel exercises on your own, but a pelvic floor PT can be extremely helpful in coaching you along and make sure you are doing exercises correctly. Did you know we have an amazing PT, Erin Lamb, located in our office?
  5. Weight loss: Extra abdominal fat can create pressure on the bladder. Losing up to 5% of your body weight be very effective for helping with urinary incontinence.
  6. Pessary: A prosthetic device that is placed into the vagina for internal support. The pessary compresses the urethra against the upper portion of the symphysis pubis and elevates the bladder neck. This causes an increase in outflow resistance and corrects the angle between the bladder and the urethra so that sneezing, laughing, or coughing alone are not strong enough to cause leakage of urine. For women who have urinary incontinence during strenuous activities such as jogging, aerobics or tennis, a pessary that is inserted before exercise may be all that is needed. This pessary is one of the oldest medical devices available and is a very safe option.
  7. Medications: Anticholinergics such as oxybutynin are effective for incontinence but have many side effects, such as dry mouth, constipation, and blurry vision. There is also an increased association with dementia. In fact, anticholinergic medications are not recommended for women > 70 years old.
  8. Consider a referral to a Urogynecologist:  There are several third-line therapies that are very effective treatment options. Below are some therapies that may be recommended based on the type of urinary incontinence you experience.
        • Surgical Repair with a mesh sling: Mesh implanted to fix stress urinary incontinence, has a very high success rate with low risk of complications. It is regarded as the best surgery to fix this type of urine leakage and involves placing a small sling of mesh material underneath the urethra.
        • Percutaneous tibial nerve stimulation: An acupuncture-like needle is inserted into the side of your ankle to cause electrical stimulation to the nerves responsible for bladder and pelvic floor function.
        • Bladder Botox injections: This helps the muscles relax, which will give you more time to get to the bathroom when you feel the need to urinate. The injections are done in the urologist’s office, and most patients tolerate the injections well. They do not “hurt” as you may expect, but you may have some short-term discomfort, which many patients have compared to a menstrual cramp. Repeating injections every 6 months is required for most effective treatment.

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