Twenty years ago the number of options for treating urinary tract problems were limited and the most common choice offered was a hysterectomy. Today, there are many more options to consider. Here are some of the more common ones:
1. Bladder training – This approach teaches you to urinate only at scheduled times and waiting longer between trips to the bathroom. Start by going to the bathroom every 30 to 60 minutes while you are awake, even if you don’t have to go. After about one week, slowly increase the time interval by thirty minutes every week.
2. Kegel exercises – These exercises are used for stress incontinence, overactive bladder and overflow incontinence. This exercise can improve symptoms of urinary loss by 25% to 50%. It’s muscle building for what is called the pelvic floor muscles. And like any other muscle building exercise, it works best if you perform a lot of repetitions. Start the next time you go to the bathroom by squeezing off the urine flow and holding it for up to 10 seconds. Start slowly, doing two sets of 10 contractions each, twice a day. Over the course of a month try to do this exercise 6 to 10 times every one to two hours of the day. By the end of a month you should begin to notice a difference.
3. Biofeedback Therapy– This is a fancy and effective tool to teach you Kegel’s exercises and improve bladder control. It uses computer graphs and sounds you can hear to show you which muscles you are exercising so you can perfect the exercises.
4. Pelvic Floor Electrical Stimulation – These devices use mild electrical stimulation to train the bladder muscles when and how to squeeze. In a way, it is a personal trainer for Kegel exercises. Fifty-five percent of women report being satisfied with this form of treatment. Although it’s not 100%, you are avoiding surgery.
5. Medications – Estrogen can be very helpful in improving the symptoms of some cases of incontinence. Studies have demonstrated improvement in 40- 70% of women. I have found that estrogen cream (one fourth to half an applicator) works better than either tablets or patches for this particular problem. Medications called antimuscarinic (examples are oxybutynin and tolterodine) can also help if the problem is caused by abnormal bladder contractions. Of course, antibiotics are the first line treatment for infection. If you don’t respond to these medications, you may be a candidate for Botox injections via cystoscopy directly into the bladder muscle.
6. Pessaries – These donut-like plastic or rubber rings are similar to a diaphragm used for birth control. They are fit into the vagina to lift and offer added support for the bladder when the pelvic muscles are weak.
7. Special devices – A new group of devices are constantly coming on to the market to block or capture urine leakage. They include absorbent products, external urine collection devices, and different types of catheters.
8. Surgery – There are many new operations that have been developed to support the bladder and improve or correct incontinence. These include implanted sacral nerve stimulators that stimulate the lower area of the spinal cord to control urine and pulsed magnetic technology that stimulates nerve impulses for bladder control. It’s called Extracorporeal Magnetic Innervation (ExMI). You don’t need to have a hysterectomy unless there are other reasons to consider it as well. Most of these operations can be performed as day surgeries. Some use laparoscopy and others only small incisions. They all are designed to repair tears in the support tissue and/or strengthen or support the urethra. Talk with your doctor about them or get a referral to a urogynecologist.
*Remember to ALWAYS talk to you doctor or medical team about anything you add to your health regimen.
Until next time,
Dr. Mache Seibel, Founder of My Menopause Magazine http://bit.ly/MyMenoMag
Professor, University of Massachusetts Medical School
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