Chapter 8: What can be done? Treatments for urinary incontinence and pelvic floor prolapse:

Non Surgical treatment for urinary incontinence

Lifestyle changes: Among the most frequently recommended life style changes for women with urinary incontinence are weight reduction, reduction of physical straining, reduction in fluid intake.

Weight reduction, although recommended for other reasons in the overweight woman, is effective in reducing incontinence only in the extremely obese patient. In most women it will have very little effect, if any, on their bladder control problems.

There is some relationship between fluid intake and stress urinary incontinence but it is very rare that stress urinary incontinence will be improved enough by just reducing the amount of fluid you take. If you suffer from nighttime frequent urination (nocturia) it is wise to watch your fluid intake and reduce it before you go to sleep (and also to empty your bladder just before you fall asleep). This is especially true if you are above 65 years old.

Other life style change recommendations tailored specifically to your needs can be made according to your voiding diary. If you drink two glasses of tea during the evening and cannot skip your favorite cup of hot chocolate just before you go to sleep, you will probably wake up and have to urinate at least twice during the night.

Reading your voiding diary and changing your habits accordingly may have a dramatic change on your bladder control problems.

Reduction of physical straining will certainly reduce the amount of leakage in women with stress urinary incontinence, but would you be willing to avoid your daily activities and a good hearty laugh with friends and family as a treatment for your incontinence. I wouldn’t. Let yourself enjoy the best jokes—we will find some other treatment for your bladder control problem.

Reduction of caffeine consumption is perhaps the most frequently recommended change of behavior advice, but it has never been scientifically proven to reduce bladder control problems. I know many doctors and patients who swear by it and I would not oppose anybody willing to try it.

Giving up smoking and reducing alcohol intake, although recommended for other reasons, has not been shown as an effective treatment of bladder control problems.

Kegel exercise

Kegel exercise, physical therapy, physiotherapy, pelvic floor exercise, pelvic floor strengthening are all synonyms to describe the same technique first described by Kegel in 1948. The idea is to strengthen the muscles of the pelvic floor and thus provide better support to the pelvic organs. Next time you urinate try to stop the flow of the urinary stream. If you cannot stop the stream, you can learn how to do it with the help of a professional. If you were able to stop the stream, you did it by contracting your pelvic floor muscles. These are the very muscles you need to exercise if you choose to adapt this mode of therapy alone or in combination with other treatment modalities.

Most women need the help of a professional to assist in recognizing this muscle group and while training. It is helpful to have a few sessions (usually 6) with a professional who will be able to teach you how to contract and train these muscles without simultaneous contraction of your abdominal muscles. Like any other type of exercise you will need a great deal of dedication and self-discipline. If you know that you do not have the right personality to keep doing this type of physiotherapy on a routine basis for a long period of time, you may be better off by not starting it in the first place. You will find yourself wasting energy, money, and most of all valuable time you could be using to look for a better therapy for you.

If you choose to try this treatment you should ask your doctor if he knows a nurse or a physical therapist specializing in pelvic floor exercises. Programs vary widely in their regimens. Usually you will need a few classes with a personal trainer (usually 6 weekly appointments). When you master the exercises you will need to keep performing them 3-4 times a week with 3 sets of 8-12 slow contractions at maximum power for 6-8 seconds each for at least 15-20 weeks and preferably to continue it for longer periods of time.

The good news is that under the right training program and by sticking to your goal, 65-75 percent of women performing this type of treatment will be cured or at least improve their stress incontinence problem. This exercise program is also of help to women with overactive bladder symptoms and urge incontinence.

To make the learning process easier your personal trainer may use a biofeedback technique. In this case it will mean that you will perform pelvic floor exercises with a small probe inside your vagina or a surface electrode placed on your skin and get an immediate graphic visual feedback on a computer monitor screen as to how well you contract your pelvic floor muscles.

Biofeedback can be provided in the form of vaginal cones of differing weights. A small vaginal cone (actually it looks more like a small egg) is inserted into the vagina. You are asked to perform daily activities for 15 minutes while trying to keep the cone from slipping out by contracting your pelvic floor muscles. Once you have gained enough control and can keep the lightest cone inside, you may move on to trying the next heavier cone. Vaginal cones are available for sale in sets of 6 cones of increasing weights. Biofeedback techniques are just adjuncts in the process of learning to perform pelvic floor exercises. They have not proven to have any added efficacy to the results of regular physiotherapy training sessions, but they may help you get there more easily.