Incontinence

[an error occurred while processing this directive] Nonsurgical Treatment for Stress Incontinence

Kegel Exercise
Kegel exercises strengthen the pelvic floor muscles (the pubococcygeous muscle group) to improve bladder control for people suffering from stress incontinence.

Success of these exercises depends on their proper execution. First, the muscle group must be located by the patient:

• Begin urinating and try to stop the flow of urine without tensing the leg muscles.
• Slow or stop the stream of urine. The muscles holding the urine are the correct muscle group.
  OR
  
• Squeeze the rectal are as if to prevent gas from passing.

• Quick contractions–rapidly tighten and relax the sphincter muscle
• Slow contractions–contract the sphincter muscle and hold to a count of 3, gradually increasing to a count of 10

Weighted vaginal cones can help women isolate the pubococcygeous muscles and are held for 15 minutes twice daily, while walking or standing.

Biofeedback
Biofeedback is practiced with Kegel exercise to reinforce proper technique. Patients visualize and identify the pelvic floor and abdominal muscles that are contracted during exercise.

A simple instrument records small electrical signals that are produced when muscles contract. The signals are instantly converted into audio and/or visual signs that help patients gain greater control over urinary muscle activity. Weak muscles can be activated on demand, tense muscles can be relaxed, and muscle activity can be coordinated.

Neuromuscular Electrical Stimulation (NMES)
This treatment is used to retrain and strengthen weak urinary muscles and improve bladder control. Electrical stimulation of the pudendal nerve causes pelvic floor and urethral sphincter muscles to contract. A probe is inserted into the vagina (when treating a woman) or the anus (when treating a man) and a current is passed through the probe at a level below the pain threshold, causing a contraction. The patient is instructed to squeeze the muscles when the current is on. After the contraction, the current is switched off for 5 to 10 seconds. Treatment sessions lasts approximately 20 to 30 minutes.

NeoControl®
This therapy is beneficial for women with stress, urge, or mixed urinary incontinence caused by weak pelvic floor muscles. The treatment is delivered through pulsating magnetic fields in the seat of a chair designed by NeoTonus, Inc. Patients sit in the chair for 20 to 30 minutes, twice a week. The magnetic pulses are aimed at the pelvic floor muscles through the seat of the chair and the muscles contract and relax with each magnetic pulse, much like Kegel exercise. It takes about 8 weeks of therapy to achieve some degree of continence.

Medication

Patients suffering from stress incontinence may benefit from alpha-adrenergic agonists, which stimulate receptors that respond to norepinephrine, a hormone and neurotransmitter. These agents should be used with caution by patients with high blood pressure (hypertension), overactive thyroid (hyperthyroidism), irregular heartbeat (arrhythymia), or heart pain caused by insufficient oxygen supply to the heart muscle (angina).

Pseudophedrine hydrochloride is also found in cough and cold preparations and antihistamines. Typical dosage is 15-30 mg, three times a day.

Ephedrine, epinephrine, and norepinephrine are alpha-adrenergic agonists that have many effects throughout the body and must be used with caution. Significant side effects include hypertension, tachycardia (rapid heart rate), and arrhythmia (irregular heartbeat).

Hormone replacement therapy (HRT) can restore the health of urethral tissues in postmenopausal women. HRT involves estrogen to heighten bladder outlet resistance by increasing blood flow, muscle tone, and nerve response in the urethra. Estrogen is given with progestin to avoid the risk for endometrial cancer. A typical dose is 0.3 to 1.25 mg per day. HRT may benefit patients with stress or mixed incontinence.

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