Bladder Retraining
Many people with urge incontinence, urgency, frequency and incontinence can be helped through the use of bladder re-training. Bladder re-training involves urinating on a set schedule during the day. The patient goes to the bathroom by the clock only, not the urge to void. For example, if the patient normally goes to the bathroom every hour or less during the day, they would start this technique by voiding every hour. After one week one should increase the time interval between voids by 30 minutes so one is now voiding every 1 hour and 30 minutes. After one week the interval is increased by another 30 minutes. This exercise is continued until the interval between voids is 3-4 hours. The patient may void at anytime during sleeping hours. This retraining program encourages the bladder to retain more urine without bladder urgency or spasms.
Urge Suppression
Patients get the urge to urinate as the bladder signals the brain by sending a message through the spinal cord. This is just a message about the filling status of the bladder; it is not a direct order to urinate. Believe it or not, a patient can and in fact, should wait, to void. The worst possible time to try to get to the bathroom "in time" is when one really has to go. A lot of people will leak especially the closer that they get to the bathroom. In an attempt to suppress the urge, patients should contract their pelvic floor muscles (i.e. Kegel exercise). Tightening and relaxing the pelvic floor muscle in rapid succession will help until the urge subsides. This will help to kick in a natural reflex that quiets down the bladder.
Pelvic Floor Stimulation (Electrical Stimulation)
This technique involves stimulation of the pelvic floor musculature using vaginal or rectal plug electrodes. Stimulation of nerve fibers leads to inhibition of bladder contractions. Physicians, Nurse Practitioners, or Physical Therapists that specialize in pelvic floor dysfunction often deliver this type of treatment.
Estrogen is also considered a helpful medication in the treatment of urinary incontinence. It works by increasing the blood supply to the vagina and urethra making the urethra more substantial and watertight.
Electrical Stimulation - Innova electrical stimulation unit (Empi, Minneapolis, MN)
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Urge Incontinence Treatment: Figure 1
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Electrical Stimulation Application - This illustration shows the electrode in place, within the vagina. The stimulator will pass a mild current of electricity through the electrode which stimulates the pelvic floor muscles to contract. This is a passive way of performing pelvic floor exercises.
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Urge Incontinence Treatment: Figure 2
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Sacral Nerve Stimulation
Sacral Nerve Stimulation (SNS) is a relatively new surgical procedure to treat urge incontinence that is not responsive to other treatments and therapies. SNS is a two-phase treatment therapy. By stimulating the sacral nerve, the signals that regulate the bladder are better in control and able to allow decreased urgency and more urine to be held in the bladder. This procedure involves having a testing procedure done first to determine the effectiveness of the treatment.
The testing portion entails placing a small wire into the lower back to the area of the sacral nerve. Once in place, the wire is taped to the person's back and connected to a small portable stimulator unit that is about the size of a pager. The person then keeps a log of their urinary symptoms and voiding episodes to determine if the treatment is effective. After discussion with the physician, the decision to implant the device is agreed upon.
The surgical procedure for implant of the Interstim® SNS therapy takes about two to four hours. There are two or three incisions: One in the lower back, the other one or two incisions is where the implantable pulse generator (IPG) is placed. The patient stays overnight in the hospital and the device is programmed one week later in the office. The patients use a hand held programmer to increase or decrease the level of stimulation. The stimulation feels like a pulsing or tingling in the rectum or vagina. The Sacral Nerve Stimulation procedure is totally reversible if the patient chooses to have it removed.
