Postural incontinence treatment involves an extensive and multifaceted strategy that may incorporate behavioral approaches (including fluid management), pharmacological treatments or surgery. Furthermore, treatment may need to evolve over a woman’s lifetime.
Assessing urinary symptoms and associated LUTS/voiding symptoms to identify which symptoms predominate (stress, urgency or mixed). Establishing clear diagnoses helps direct management strategies as well as assess how urinary incontinence impacts quality of life.
Pelvic Floor Exercises
The pelvic floor is a layer of muscle that covers the bottom of your pelvis and supports organs such as your bladder and bowel. Not only does it aid with urinary and bowel function but it also works alongside core muscle groups to keep you standing up straight.
Annabelle Citroen, physiotherapist for bladder, bowel and pelvic health states that good posture is crucial to improving bladder, bowel and pelvic wellbeing. Not only does it keep you active and alert but it can reduce muscle stress throughout your abdomen, spine and back reducing strain on those areas as well.
Postural incontinence treatment involves performing exercises to strengthen pelvic floor muscles. These can include Kegels (squeezing pelvic floor muscles) and pelvic floor stretches; physical therapists who specialize in pelvic floor physical therapy can offer assistance in safely performing them effectively.
Many individuals can find great benefit in engaging in pelvic floor muscle exercises to increase urinary continence and decrease their need for medical treatments like pessaries or urethral inserts. Furthermore, such exercises may even prevent incontinence altogether.
Certain women may be more vulnerable to urinary incontinence after childbirth or due to injuries that weaken or damage the pelvic floor, but anyone can benefit from pelvic floor exercises in order to increase bowel and bladder control.
Physical therapists can teach you how to perform these exercises, using techniques such as biofeedback to find which muscles need to be compressed. Furthermore, they may help modify these exercises so they are suitable for your body type.
To gain more information on pelvic floor exercise and treatments for urinary incontinence, seek medical advice. Your physician may prescribe medications or recommend other methods such as urethral inserts or electrical stimulation as treatments.
Pelvic floor muscle exercises are one of the most frequently prescribed incontinence treatments, according to Harvard Women’s Health Watch. They may help stop leakage caused by laughter or other activities which exert pressure on the bladder, and Harvard Women’s Health Watch suggests they can help stop leakage occurring after laughing or other activities which put additional stress on it.
Exercise to combat urinary incontinence that occurs with age or medical issues like diabetes. Although effective, these exercises can be uncomfortable depending on your bladder strength.
Postural incontinence, caused by weak pelvic floor muscles, is one of the most frequently occurring forms of urinary incontinence. Treatment should focus on identifying its source and using measures that prevent urine leakage.
Women typically turn to Kegel exercises or behavioral techniques such as Kegel for strengthening pelvic floor muscles and keeping the bladder closed, and if these don’t help then surgical intervention may be the next step.
Anticholinergic medications may be effective at helping with incontinence. Such anticholinergics can tighten or decrease bladder leakage. Furthermore, these anticholinergics may improve sleep if incontinence interferes with restful rest.
Other medications may help to increase muscle tone and close off the urethra more securely. Such remedies may be administered either directly to the urethra or sublingually into vagina.
Urethral inserts are silicone tubes designed to fit snugly inside the urethra opening to form a seal around the bladder neck, usually worn for several hours or overnight, before being taken off before urination and replaced by another insert.
These devices are not meant to treat incontinence; rather they should be used with care and should be cleaned weekly to remain effective. Some individuals may find the use of such devices uncomfortable while they can even cause serious side effects like urinary tract infections.
If the sphincter muscles become ineffective or completely nonfunctional, doctors can implant an artificial internal sphincter. This is typically used by men suffering incontinence after radical prostatectomy (the removal of their prostate gland due to prostate cancer).
Stress incontinence treatment options include performing sling procedures using synthetic mesh materials as midline supports to the urethra. These minimally invasive and successful procedures offer great solutions.
Retropubic colposuspension, commonly known as Marshall-Marchetti Krantz (MMK) procedure, is one of the primary approaches used to treat stress incontinence. This treatment method involves placing a lateral suture through thick bands of muscles running along the pubic bone. This procedure may be conducted either open surgery or laparoscopy using either spinal or general anesthesia as appropriate.
Women suffering from stress incontinence have several treatment options available to them, including bladder slinging. This procedure may be combined with sacrocolpopexy – which repairs prolapse of the uterus and/or bladder from their pelvic cavity into vagina – for greater efficacy. A bladder sling may also provide less invasive relief than Burch colposuspension or MMK procedures.
Pessaries are small silicone devices designed to support your bladder, uterus or rectum and is an effective treatment option for pelvic organ prolapse (POP).
Pelvic organ prolapse occurs when one or more of your pelvic organs – such as your bladder, uterus or rectum – protrudes through your vagina. This may result in symptoms such as pressure or heaviness in the vagina, incontinence and pain in addition to discomfort and incontinence.
Pessaries used correctly can help women reduce POP and urinary incontinence, improve quality of life, and decrease POP symptoms. They do require periodic cleaning and reinsertion by your healthcare provider.
Your doctor will help you select a pessary that best meets your condition by conducting an in-depth vaginal exam and trying out various styles and sizes until she finds one that suits you perfectly.
Once she finds a pessary that works best for you, your doctor will teach you how to insert and use it properly. She will also demonstrate how to take off and clean your device.
Depending on the type of pessary you wear, you may need to perform these steps every 6-8 weeks at home or at your doctor’s office. Some types of pessaries – like cubes – allow users to insert and remove devices on their own.
Gellhorn pessaries, however, fill your vagina and cannot be removed while sexual activity takes place. Although difficult to insert properly, your physician can offer guidance as to how best to insert these pessaries.
Follow-up appointments should take place 1-2 weeks post insertion to assess how well the pessary is working and to monitor any worsening incontinence issues. At these appointments, your physician will inspect your vaginal area closely for pressure points, abrasions or erosion that might appear.
At its core, comfort should always come first when choosing a pessary. Otherwise, its efficacy will suffer dramatically. A quality fit pessary should be lightweight and easy to remove for removal without disrupting voiding capabilities or restricting movement during physical activities such as sports.
Electrical stimulation may help your bladder be under better control. NYU Langone physicians offer noninvasive or invasive electrical therapy treatments designed to stimulate nerves associated with controlling your bladder and pelvic floor.
Electrical stimulation is a popular treatment option for urinary incontinence, used both for overactive bladder (OAB) and urge incontinence. A doctor will use an electrical current passed through your vaginal or anal tubes to contract your bladder muscles and help with treatment.
Another treatment option involves implanting electrodes beneath your skin connected to a battery-powered device that you wear during the day, stimulating tibial nerves in your lower leg while sending electrical pulses directly to sacral nerves in your lower back which are thought to play a part in controlling bladder activity.
Under invasive sacral neuromodulation, a doctor inserts electrodes through a needle inserted under your skin near your buttocks and sends pulses from them directly into one of your sacral nerve roots in your lower back – this controls bladder and pelvic floor function.
If your incontinence stems from an injury or chronic condition, electrical stim may be used as part of a rehabilitation program to strengthen muscles and promote overall wellness.
Electrical Stim sessions typically last 15 minutes; however, you can extend their duration as long as necessary. Your physical therapist may also give instructions for performing electrical stim treatments at home by placing electrodes over your abdomen and pelvic area and controlling the device.
Your doctor will assess your symptoms to identify which form of electrical stimulation will best benefit you. Studies have indicated that tibial nerve stimulation can alleviate symptoms while sacral nerve stimulation has similar success.
Some forms of tibial nerve stimulation require batteries that must be changed periodically, as well as possible side effects and the ineffectiveness in treating urinary retention, a less severe form of incontinence.