Urinary Incontinence : Diagnosis and Treatment

by Food and Drug Administration (FDA)

(Page 2 of 4)

Successful treatment starts with a doctor's evaluation to determine the type of incontinence and the cause. The patient may be referred to a urologist, a doctor who specializes in treating problems of the urinary tract and bladder in both women and men, or to a urogynecologist, a gynecologist by training who focuses on women's urinary problems.

The evaluation usually includes a medical history, a physical examination, and a test to check the bladder storage and emptying functions (urodynamic testing).

Leng stresses the importance of a thorough evaluation and discussion of treatments so that "the patient and I are on the same page, and so we have the same expectations. Treatment should be very much custom-tailored to the individual patient."

"There are varying degrees of treatments," says Janine Morris, Chief of the FDA's Urology and Lithotripsy Devices Branch. "They go from conservative therapy to surgery. All are for managing symptoms, and all have benefits and drawbacks."

Treatment options fall into four broad categories: behavioral, medications, devices, and surgery.

Behavioral Therapy

Behavioral therapies are noninvasive, free of side effects, and don't limit further treatment options. These therapies include "retraining" the bladder and doing exercises called Kegels.

Bladder retraining helps the bladder to hold urine for longer periods of time. The individual is instructed to empty the bladder at scheduled times during the day, and then to gradually extend the time between bathroom trips.

For stress incontinence, a doctor may recommend Kegel exercises to strengthen the muscles below the bladder (pelvic floor muscles) that hold in urine. These exercises for women and men involve repeatedly tightening, holding, and then relaxing the pelvic floor muscles.

Leng advocates Kegels for patients with mild incontinence. "And like any exercise, it's only effective as long as you continue doing it."

Some people can't tell whether they are doing the exercises correctly. "A lot of women try to do the exercises on their own and give up," says Leng, who refers patients to a physical therapist to teach them to use the proper muscles. Specialists may use biofeedback devices that indicate a muscle contraction when the correct muscle is exercised. Some biofeedback devices are sold over-the-counter for home use.

Medications

Another treatment option is medication, as seen in those "gotta go" television ads. The drugs in those ads are for treating overactive bladder, or urge incontinence, says George Benson, M.D., a urologist in the FDA's Division of Reproductive and Urologic Drug Products. No drugs are approved for stress incontinence.

For many years, only two drugs were approved to treat overactive bladder: Detrol (tolterodine tartrate) and Ditropan (oxybutynin chloride). In 2004, the FDA approved three more drugs: Sanctura (trospium chloride), Enablex (darifenacin), and Vesicare (solifenacin succinate). All of these medications come in pill form, and oxybutynin is also available as a skin patch.

"All five drugs work in essentially the same way to decrease urgency, frequency, and urge incontinence," says Benson. "They block the nerve impulses to the bladder that cause it to contract and leak." Side effects of the drugs include dry mouth, constipation, headache, and blurred vision.

Other drugs called alpha-blockers and 5-alpha reductase inhibitors may be prescribed for men with incontinence problems due to an enlarged prostate. Alpha-blockers relax the prostate and bladder neck, allowing improved urine flow; 5-alpha reductase inhibitors hinder the production of a male hormone believed to be responsible for prostate enlargement.

Nonsurgical Devices

Some men and women with stress or urge incontinence are helped with electrical stimulation devices, which help strengthen the pelvic floor muscles. Mild, painless electrical pulses are sent to these muscles through electrodes temporarily placed in the rectum or vagina.

Another stimulation device, available in some urology facilities, is the NeoControl Pelvic Floor Therapy System. This noninvasive treatment, developed by Neotonus Inc. of Marietta, Ga., is cleared for use in women with stress, urge, or mixed incontinence. The woman sits fully clothed in a special chair that aims magnetic pulses at the pelvic floor muscles. "It acts similar to the electrical muscle stimulators to improve muscle tone of the pelvic floor," says Morris.

Other device options for women with stress incontinence are urethral "plugs" and pessaries. A woman inserts a plug into the urethra, where it seals off the flow of urine. It's removed during routine urination, disposed of, and replaced with a new one as needed. Pessaries are synthetic or rubber devices of various shapes intended to occupy space within the vagina. A health professional fits and inserts a pessary into the vagina, where it helps support the pelvic organs to reduce leakage. Women who use urethral inserts and pessaries need to watch for possible urinary tract and vaginal infections.

Devices for men include clamps and compression rings that fit over the penis to squeeze the urethra shut. These must be removed to empty the bladder. Possible side effects are pain and tissue erosion when these devices are not used properly.

About the Author

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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.