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Minimally Invasive Management of Urinary Incontinence

Urinary incontinence affects almost 13 million people in the US alone, which makes it a commonly seen problem. Most patients do not report this condition, although urinary incontinence is now easy to manage and treat.

What happens normally?

Urinary function is performed due to ideal coordination between the brain and the urinary tract. The bladder, which stores the urine, is covered with a smooth layer of muscle (detrusor muscle). This helps the bladder to relax while filling up and contract when expelling the urine out. The bladder has the urethral sphincter and bladder neck which control the flow of the urine in the right direction.

While urinating, the bladder neck opens, the sphincter is relaxed and the bladder muscles contract. Incontinence occurs in case the bladder neck is not able to work properly (stress incontinence) or bladder muscle becomes overactive and involuntary contracts (urge incontinence).

What is urinary incontinence?

Urinary incontinence refers to the condition where the patient experiences involuntary loss of urine. This is not necessary a part of the ageing process. It is a commonly seen condition and affects men and women of all ages.

What are the types of urinary incontinence?

Urinary incontinence is differentiated into different types, such as:

Stress urinary incontinence

This occurs when the leakage increased with pressure on the abdomen, such as during physical activities (laughing, coughing, sneezing, standing up, etc). Damaged pelvic muscles are mainly to blame for this condition. This may be the result of pregnancy and childbirth.

Urge urinary incontinence

This is also known as ‘overactive bladder’ and results in an uncontrollable and sudden urge to urinate. Mostly, the patient with this condition may leak some amount of urine unknowingly. Ageing, obstruction or flow of urine, diet with bladder irritants, etc are known to result in this condition.

Mixed urinary incontinence

This is a combination of the urge and stress urinary incontinence conditions.

Overflow urinary incontinence

This condition is caused when the bladder does not empty sufficiently and the urine produced is more than the capacity of the bladder. Symptoms of dribbling and frequent urination point towards this condition. An obstruction in the urine flow and loss of bladder muscle control may cause the development of this type of urinary incontinence.

How is the minimally invasive management for urinary incontinence done?

As some of the causes of urinary incontinence are temporary the condition is easy to remedy. These include UTI, medication reaction, vaginal irritation/infection and restricted mobility.

In other cases, advanced medical intervention is required to treat the causes and the symptoms. Minimally invasive management of urinary incontinence does not involve surgery and is ideally the first choice of treatment for patients. At times, the minimally invasive methods may also be combined with conventional surgical treatment methods for better effectiveness.

Fluid management

This technique involves instructing the patient about managing the level of essential fluids in their bodies. Patients may need to decrease the consumption of caffeine and other food that irritate the bowel (colas, coffee, tea and acidic fruit juices). The doctor may also advise to intake excess water to flush out the irritants from the urinary system.

Bladder training

Initially, a diary needs to be maintained to record details such as fluid intake amount and frequency, urination times and frequency of urination, etc. This provides immense information about the condition. The diary is also a way to designate specific times for a bathroom break to train the bladder to discharge at set intervals of time. Regular emptying of the bladder will result in decreased risk of incontinence. Urge and stress urinary incontinence can be managed in a better way using this.

Bladder retraining

This is useful for treating abnormal urinary frequency. The main aim of this treatment is to increase the amount of urine that can be effectively stored in the bladder consciously by the patient. Maintaining a diary to record details of fluid intake, regular urinating times, etc helps to give the bladder a habit of emptying at set intervals and on command.

Pelvic floor exercises

These are commonly called as Kegel exercises and are aimed at strengthening the pelvic muscles and the external sphincter muscle. Contracting and relaxing the pelvic floor muscles can help the patient to improve the muscle strength. This helps to have better control over the functions of these muscles and prevent unwanted urine leakage. Patients suffering from stress incontinence and urge incontinence are vastly relieved of the symptoms of urinary incontinence.

Medicinal treatment

There are certain medicinal drugs that are helpful in case of stress incontinence as these help to tighten the bladder neck muscles. The ingredients of these drugs results in contraction of the bladder neck muscles and help to regulate the flow of urine in a better way. Patients with a history of hypertension are not administered these medicines.

The other types of medicines help the smooth detrus muscles to relax and at the same time the bladder neck muscles contract. Advanced medicinal drugs are available that are devoid of the unwanted side-effects that were seen with conventional medicinal drugs.

What is the outcome after minimally invasive management of urinary incontinence?

Minimally invasive therapies for managing and treating urinary incontinence show significant improvement in the symptoms but are not the cure for this condition. The improvement seen is gradual, yet steady. Patients will normally require time to adapt to the change in behavior. Pelvic floor exercises may show results after 3 to 6 months. Medical therapy may show an effect on some patients within a short period of time but can take longer than 4 weeks in others.

Incontinence may also recur after initial treatment. Recurrence can be avoided by following the doctor’s advice thoroughly in taking the medication or performing pelvic floor exercises. Good toilet habits, such as frequent and timely urination, avoiding constipation and bladder irritants can help to prevent urinary incontinence from recurring.

Frequently asked questions:

What to do if there is incontinence?

It is advised to consult your physician or an experienced urologist in case symptoms of urinary incontinence are discovered. Provide the doctor with the list of medications you take along with your medical history so they can make a better diagnosis and give advice on the best-suited treatment for it. Providing the doctor with the schedule of urinating and incontinence for better diagnosis is also a good idea.

What should I do about the urinary incontinence before visiting the doctor?

Try and urinate at intervals of 2 to 3 hours when awake and drink about 6 to 8 glasses of water daily. Try and avoid bladder irritants in diet and also avoid constipation. Perform pelvic floor exercises regularly.

What types of foods are bladder irritants?

Caffeine is the most commonly ingested food item which irritates the bladder. There are other types of food and drinks that cause bladder irritation as well. These include alcohol, carbonated drinks, tea or coffee (even decaffeinated), citrus fruits, chocolate, acidic fruit juices and tomatoes.

How to tell whether I am doing the pelvic floor exercises correctly?

The exercise should be able to move only the pelvic floor muscles. Tightening of the pelvic floor muscles is important for stopping the flow of urine on command or to stop the passage of gas.

The abdominal, leg and buttock muscles should not be tightened. Place a mirror in front or put a hand on your abdomen while performing the exercise to feel whether other muscles are being used. These are fairly simple exercises and can be done almost anywhere. Support groups and healthcare providers provide extensive literature with instructions and tips to perform Kegel exercises.

Can medication cause urinary incontinence?

There are certain types of medicinal drugs that can cause or exaggerate urinary incontinence. These include sedatives, diuretics, antidepressants, narcotics, calcium channel-blockers, antihistamines and alpha-blockers.

Will my urinary incontinence worsen with age?

Urinary incontinence normally does not get worse with the passage of time but will not improve also without adequate treatment.

If I have some incontinence which does not bother me, do I still need treatment for it?

Any involuntary leakage of urine is abnormal. Treatment should be considered if the incontinence results in hampering normal everyday activities. Treatment may become necessary if you wish to avoid wearing pads or diapers to prevent embarrassment.

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