Urge Incontinence In Women: Treatment Methods

Urge incontinence treatment
Understanding how to manage urge incontinence effectively involves a blend of behavioural modifications, medical interventions, and, in certain cases, surgical procedures. This tailored approach ensures that treatment is adaptable to the specific needs and conditions of each individual.

Behavioural treatments

Behavioural techniques are often the first line of defence in managing urge incontinence. These non-invasive strategies are beneficial in teaching patients how to control their bladder and bowel movements more effectively:

• Bladder training: This involves extending the time between trips to the bathroom. Starting with small intervals, such as every hour, and gradually increasing the duration can significantly help train the bladder to hold urine longer, reducing the frequency of urge incontinence episodes.

• Timed voiding: By keeping a diary of urination and leakage, individuals can begin to notice patterns and plan trips to the bathroom to prevent accidents, thereby gaining better control over incontinence.

• Pelvic floor exercises: Also known as Kegel exercises, these involve tightening and relaxing the muscles that control urine flow. Regular practice strengthens the pelvic floor, which supports the bladder and reduces the symptoms of urge incontinence.

Medicinal interventions

When behavioural methods are insufficient, medications may be prescribed to alleviate the symptoms instead:

• Antimuscarinics: These medications, such as oxybutynin, tolterodine, and darifenacin, relax the bladder, reduce urinary frequency, and prevent involuntary contractions. They are typically started at a low dose to minimise side effects, with adjustments made based on effectiveness and tolerance.

• Mirabegron: This alternative medication is used when antimuscarinics are not suitable or cause adverse effects. Mirabegron works by relaxing the bladder muscle, thus increasing bladder capacity and decreasing the instances of leakage.

Advanced treatments

In cases where medication and behavioural therapies do not yield satisfactory results, more invasive options may be considered:

• Biofeedback: Utilising sensors that monitor the bodily functions, biofeedback helps patients gain better control over their pelvic muscles and bladder.

• Botulinum toxin A injections: Commonly known as Botox, these injections can increase the bladder's storage capacity and reduce episodes of leakage.

• Hormone therapies: Particularly for women, using hormones like oestrogen alone or in combination with progesterone can help manage symptoms.

• Sacral nerve stimulation: This involves sending a mild electrical signal to the nerves that influence bladder control, helping reduce abnormal bladder contractions.

• Surgical options: Surgery is considered only after all other treatments have been explored. It is reserved for severe cases or when structural abnormalities cause the symptoms.

In complex cases of urge incontinence, where diagnosis remains uncertain or treatments have not yielded expected improvements, doctors may recommend further diagnostic assessments. Such scenarios include:

• Unresolved diagnostic questions: When initial tests don't provide clear results or when symptoms are atypical.

• Treatment resistance: If standard treatments fail or symptoms persist despite treatment efforts.

• Pre-surgical evaluation: Before considering surgical options, to ensure all other possibilities have been exhausted.

• Complicated medical history: Presence of other conditions like recurring infections or neurological issues that might influence incontinence.

Types of Diagnostic Tests

• Urodynamic studies: These are critical for understanding how well the bladder and urethra are functioning. They help identify involuntary bladder contractions, bladder storage pressures, and urethral function which are vital in diagnosing urgency incontinence.

• Cystometrogram: Measures how the bladder behaves when it fills with fluid, noting any involuntary contractions or sensations of urgency.

• Stress testing: Simulates conditions that might cause urine leakage, such as coughing or sudden movements, to observe bladder stability.

• Urethral pressure profile: Assesses the strength and function of the urethra, which is crucial for maintaining continence.

• Uroflowmetry: Gauges the flow and force of urination, providing insights into potential obstructions or weaknesses.

• Cystoscopy: This procedure allows doctors to look directly inside the bladder and urethra, identifying any structural abnormalities, stones, or unusual growths.

• Imaging tests: To visualise the urinary tract's structure and to detect anomalies that might not be apparent with other tests.

• Intravenous pyelogram (IVP): A dye is injected into the bloodstream, and X-rays are taken to track the dye's flow through the urinary tract.

• CT scan: Offers a detailed cross-sectional view of the abdominal and pelvic area, helping to identify stones, tumours, or other abnormalities.

• Ultrasound: Uses sound waves to create images of the urinary tract, useful for detecting masses, kidney stones, or other changes in the kidneys and bladder.