Urinary Incontinenc: Treatments, Part 2

by Food and Drug Administration (FDA)

(Page 3 of 3)

Other Treatments

Medications are another treatment option. "I found in my practice that a lot of people can be treated with medication," says Dan Shames, M.D., a urologist in FDA's reproductive and urologic drug products division who had a clinical practice for nearly 20 years.

In general, the drugs available are approved only for urge incontinence. These include anticholinergics, such as propantheline, and antispasmodics such as oxybutynin. They work by relaxing the bladder muscles to stop abnormal contractions.

Unfortunately, some drugs have numerous side effects, such as severe dry mouth, blurred vision, and constipation. "A lot of people stop using them because they can't handle the side effects at the level that gives them relief," Shames says. But, he adds, drug companies are trying to develop drugs that work as well or better with fewer adverse effects. "There are more approval requests for new drugs for incontinence," he says.

Some women don't experience incontinence until after menopause, and for them estrogen replacement may help. The hormone estrogen plays a role in keeping the lining of the urethra plump and toned.

In some cases, surgery to correct anatomical problems or implant devices remains the best treatment. Most people do not need surgery, but of those who do most become continent again. For example, surgery can remove blockages. Or sometimes collagen is injected around the urethra. Collagen, a naturally occurring structural protein, is used to add bulk to the surrounding tissue, thus narrowing the urethra and increasing resistance to urine flow. This method seems to work better in women.

For women with stress incontinence, other surgery options include improving the bladder neck position, and supporting or replacing severely weakened pelvic muscles. People with extremely small bladders may be candidates for an enlargement operation. Implanting an artificial urinary sphincter may be appropriate in some people. For people who are incontinent because of faulty nerves to the bladder, an implanted stimulation device is under investigation.

A last alternative is one of two types of catheters. Both are placed into the bladder through the urethra to drain the bladder. The Foley catheter is left in place; with an intermittent catheter, the patient inserts it as needed.

Education Is Key

Despite how prevalent and treatable incontinence is, a variety of national and international professional organizations, including the National Institutes of Health, have noted a lack of professional and public knowledge about incontinence and its treatment. "Most physicians have never had any education about incontinence," Resnick says.

Sant agrees, but he has noticed the beginning of an encouraging trend. "We're seeing a change in the approach, not only on the part of physicians, but also in the expectations and demands of the patients — which I think is excellent," Sant says. "Women are now saying, 'Look, we don't have to live with this.'"

Apparently, the word is spreading that incontinence is neither inevitable nor shameful but instead treatable or, at least, manageable.

Facing Facts About Urinary Incontinence

Myth: There's nothing that can be done about it.

Fact: There's a lot that can be done. In the majority of cases, continence can be restored or improved with behavioral techniques, devices, drugs, or surgery.

Myth: Incontinence is a normal consequence of aging.

Fact: Incontinence is never normal at any age, according to Neil Resnick, M.D., chief of gerontology at Brigham and Women's Hospital, Boston. Age-related changes in the lower urinary tract may make older people more likely to experience incontinence, but for most older people, even the very old and frail, incontinence can be treated successfully.

Myth: The only successful treatment is surgery.

Fact: The majority of patients can be helped with other treatments.

Myth: Incontinence is inevitable for women who have given birth.

Fact: Giving birth can injure or weaken the pelvic region, but that doesn't mean incontinence is inevitable. Exercises often help.

Myth: A little leakage sometimes, such as during a sneeze or cough, is no big deal. It's not worth telling the doctor about.

Fact: If urinary leakage is troubling at all, it's worth mentioning to the doctor. People can learn to manage the problem — or be free of it altogether.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.