Urinary incontinence: solutions exist!

Urinary leakage quickly becomes a handicap if it is not discussed with your doctor. This makes it possible to determine what type of incontinence one suffers from (stress incontinence or by emergency room) and to set up a suitable solution. Perineum rehabilitation, medication, surgery: update on treatments.

1. Three types of urinary incontinence
2. Establish the diagnosis of incontinence
3. Rehabilitation of the perineum as a first treatment
4. Medicines to calm overactive bladder
5. The use of absorbent protections
6. Surgery of last resort for urinary incontinence

Urinary incontinence is not a disease as such, but the symptom of a physical, neurological or psychological disorder . It is characterized by involuntary leakage of urine in the form of drops or spray. As soon as urinary leakage becomes persistent and bothersome, it is essential to consult a general practitioner, a gynecologist or a urologist in order to put in place the appropriate solutions.

Three types of urinary incontinence

We distinguish :

the urinary incontinence : leakage occur during exercise: physical activity, coughing or sneezing, laughing, carrying loads ...

Urinary incontinence due to urgency ( overactive bladder ), which is characterized by the impossibility of retaining a pressing urge to urinate, frequently associated with the presence of urgent needs to urinate (with or without leakage).

the mixed urinary incontinence .

Establish the diagnosis of incontinence

The diagnosis is first clinical: questioning the patient to identify the circumstances in which the leaks occur, then clinical examination. In particular, we perform an anatomical examination of the small pelvis to verify that there is no malformation or prolapse (organ descent). We are also trying to determine a possible vaginal dryness  testifying to an estrogen deficiency.

Different quick and simple tests can be prescribed to determine the causes of incontinence .

A urinalysis is requested, looking for a possible infectious origin.

It is also recommended to keep a voiding catalog , i.e. to note the time and volume (with a measuring cup) of voiding for two days.

Then the urologist performs further examinations. He can check the emptying of the bladder by ultrasound .

A urodynamic workup is prescribed before a surgical solution: this involves checking the pressure in the bladder and the urethra using a probe.

Rehabilitation of the perineum as a first treatment

Perineal rehabilitation is always offered as the first treatment for incontinence. It consists, with the help of the physiotherapist, in remusculating his perineum . It also includes behavioral methods aimed at relearning, as the case may be, urinating regularly (so as not to end up with a bladder that "overflows") or conversely at spacing your urination (in case of too frequent urges to urinate) .

Perineal rehabilitation is effective on all types of incontinence.

Medicines to calm overactive bladder

Drug treatment is available only in case of incontinence by urgency: these drugs of the class of anticholinergics allow to calm the hypersensitivity of the bladder, but its side effects (dry mouth, constipation ...) sometimes make it difficult to bear. A new drug from the class of B3-agonists , without the side effects of anticholinergics, is available today and can be used in certain cases.

In case of vaginal dryness , a prescription of vaginal estrogens is generally recommended, in combination or not with hormone treatment if the woman is menopausal .

The use of absorbent protections

Several types of products provide comfort to maintain daily activities.

The majority of incontinence treatment in Bangalore people go to absorbent protections , which are available according to everyone's expectations: briefs, complete diapers, shells for men ... They are suitable for nights, and the materials are close to the textile sensation. However, they are not reimbursed by Social Security.

Men can wear a penis case . It is a kind of condom that is connected to a collection bag. Well fixed, it does not cause urine leaks or odors. Significant advantage, penis cases are reimbursed by Social Security.

In addition to absorbent protections, women with mild to moderate incontinence can use a specific tampon to prevent urinary leakage for a few hours, for example, the time of a physical activity or an outing. This product is reimbursed by Social Security.

Surgery of last resort for urinary incontinence

Surgery, when possible, is a solution in the event of perineal rehabilitation failure. But it is only offered to people who feel they can no longer bear their urinary incontinence. "urine leak treatment in Bangalore only operate on people who are embarrassed and motivated," says urologist Dr, Praveen Joshi.

Four surgical solutions are possible depending on the causes and type of incontinence.

The insertion of a sub-urethral strip is a benign procedure which consists in placing a strip under the urethra to keep it in good position.

Two adjustable peri-urethral balloons , filled with physiological saline, can be placed on either side of the urethra: by exerting pressure, they replace the function of the sphincter.

The installation of an artificial urinary system is a heavier operation in the event of a sphincter insufficiency, that is to say of the muscles which close the channel of the urethra.

The neuromodulation of the sacral roots is offered to people with incontinence urge incontinence and why the medication would not work. Dr. Praveen joshi defines it as a "bladder pacemaker" acting on the nerves of the bladder.

Another recent solution: the injection of botulinum toxin into the bladder, but the effect is transient (a few months). The procedure is performed under light anesthesia by the endoscopic route.

Medication for urinary incontinence

Urinary incontinence manifested by uncontrolled urinary leakage should no longer cause shame and withdrawal in the person affected. This pathology can be treated or reduced, as soon as the person decides to consult a doctor, urologist or gynecologist. Behavioral habits to acquire, diet to monitor, new lifestyle habits to adopt, perineal reeducation techniques, are some of the recommended ways to treat incontinence. Taking medication may also be necessary and be an effective solution, especially in the case of urge incontinence.

Medication for urinary incontinence

A person suffering from urinary incontinence should not take the initiative to seek treatment at incontinence treatment in Bangalore without the advice of a specialist. After a series of interviews and examinations to define the type of incontinence, only the doctor can determine the appropriate treatment.

Stress urinary incontinence, which occurs during a cough, sneeze or following physical exertion, is generally treated by rehabilitation or surgical intervention and not by medication. Perineal rehabilitation works by strengthening the perineum and the sphincters. In the event of failure, the surgical treatment is indicated: most often the installation of strips under urethral. To date, no medication is indicated for the treatment of stress urinary incontinence. Alpha-mimetics or certain inhibitors of serotonin reuptake had been considered, but they were not very effective and had too many contraindications and side effects. Only taking estrogens can sometimes be associated with rehabilitation, this allows muscle building.

In contrast, drugs have been shown to be effective in treating the other two types of urinary incontinence: urge urgency, which manifests as urinary leakage preceded by an urgent need to urinate, and mixed incontinence, which combines urinary stress incontinence to urge incontinence. These drugs work by blocking out of order bladder contractions.

Drug treatment

The bladder contracts under the effect of a molecule called acetylcholine, which attaches to receptors located on the bladder wall.

Certain drugs, such as anticholinergics, by implanting themselves on the receptors of the bladder, therefore have the role of reducing involuntary contractions of the latter. Other drugs, by their anti spasmodic effect, also aim to help the bladder to relax and reduce contractions. This is the case of muscle relaxants in particular. However, considered less convincing than anticholinergics, they are much less used than the latter.

Anticholinergics: the most prescribed drugs against urinary incontinence.

Having the role of "immobilizing" the receptors and reducing the contractions of the bladder and the pressure inside it, anticholinergics are still the most popular drugs to reduce volume and frequency of urinary leakage . However, they cause a number of side effects, the best known of which are: eye disorders, dry mouth, constipation, gastrointestinal disorders, drowsiness and tachycardia. Sometimes, disturbances of consciousness are noted in the patient, especially the elderly.

These side effects, and particularly dry mouth, are also the main cause of interruption of treatment by patients. The appearance and nature of side effects may be different depending on the patient, it is always recommended to seek the advice of your doctor when taking these drugs. To minimize the onset of side effects, some doctors recommend administration in low doses, especially in the elderly. They also recommend waiting up to 4 weeks to assess the effectiveness of the drugs, and gradually changing the dosage.

New drugs have appeared and would have the quality of being both effective and more tolerated by patients. Others can be used "as a second line" to treat cases of intolerance to anticholinergics, such as anticalcics, or anti inflammatory drugs. Other drugs like botox used initially to treat certain neurological diseases like multiple sclerosis has given good results to treat urinary incontinence by overactive bladder and it is more and more used today.

All medications to treat urinary incontinence should be prescribed by a doctor. This is why, it is strongly advised to consult a doctor who will direct the patient to a specialist. After researching and finding the causes of incontinence, the doctor will be able to determine whether or not the most suitable treatment requires the absorption of medication. In most cases, the doctor favors perineal reeducation or recommends adopting new behaviors, changing certain eating habits. These measures are simple and constitute the best means of prevention, because with the increase in life expectancy, urinary incontinence is likely, within a few years, to become a real public health issue.