Incontinence: Conservative Treatments for Stress Incontinence

Pelvic Floor Exercises (Kegel exercises)

This is the exercise which, when done faithfully and correctly, can help decrease the urgency a patient may have and help with both urge incontinence and stress incontinence. The pelvic floor muscle is like a hammock that stretches from the pubic bone in the front to the tailbone in the back. This set of muscles supports the organs of the pelvic region, which include the bladder, large intestines and uterus. Since this muscle is often not exercised, it is generally weak to begin with, which contributes to urinary symptoms. Childbirth will weaken this muscle more because during vaginal delivery, the child's head and body push under the pelvic floor muscle and stretches it extensively which causes temporary additional damage/weakening. Learning to do these exercises can help with incontinence, however to perform these exercises effectively the patient must first identify the correct muscles.

Two methods of identifying the correct muscles:

• While urinating stop the flow of urine by tightening the pelvic floor muscles. Do not perform these exercises while urinating, since this can lead to difficulty in voiding. Stopping and starting the stream as a person voids is a popular misnomer and should not be done. Patients may elect to try to stop the stream once or twice to check for contraction of the correct muscle.
• Place a finger in the vaginal opening and attempt to squeeze the finger. Upon squeezing, the patient should feel a tightening around her finger. She has identified the correct muscles that are to be exercised.

One key point is that patients do not want to use other muscles, such as the abdomen, legs or buttocks. It is important to isolate the muscles only to further increase their strength. If you are moving these muscles or holding your breath, you are probably trying too hard!

Concentrate just on the pelvic floor muscles and do the best you can. This contraction will get easier with practice. One exercise program is described below:

• Attempt to contract and hold the muscle squeeze for 10 seconds
• Relax for a period of 10 seconds
• Perform 10-15 contractions and relaxation
• Perform this regimen 3-4 times a day

It may take awhile to work up to a 10 second hold. In the beginning, you will probably not be able to hold for more than five or six seconds and that is all right. Between each contraction, relax for 10 seconds. This allows the muscle to rest adequately to be able to perform well for the next contraction. If you do not relax the muscle well enough, the muscles will tire quickly. By faithfully doing your Kegel exercises, you should see an improvement in your symptoms starting in four to six weeks.

Urethral Opening Occlusion Devices

There are several new non-surgical products on the market for female stress urinary incontinence. Brand names are listed:

• CapSure® and FemAssist®. - This type of device creates enough suction to keep the walls of the urethra together during stressful activities where someone might otherwise leak. The patient places a small amount of Vaseline-like material on the suction cup and places it in the area of the urethral opening, which is just above the vaginal opening. The placement does not have to be exact and once the device is in place the labia fold over it and the device cannot be seen or felt. When the patient needs to urinate, the suction cup is easily pulled off. The device is washed with soap and water and dried and is re-usable.
• Reliance® - is an inter-urethral insert. This product requires the patient to insert a small catheter/plug into the urethra (tube that the urine travels through from the bladder to the toilet). These devices are comfortable to wear and when the patient needs to urinate, she pulls on a string, much like a tampon, to remove the device. When finished urinating, a new device is replaced in the urethra. There is a higher rate of urinary tract infections with this product versus the ones listed in the prior paragraph.
• Tampons - can also be used for stress incontinence activity based leakage. Placing a tampon in the vagina acts as a support or buttress for the urethra and bladder. Supporting this area can reduce urine leakage with coughing, sneezing, bearing down (Valsalva maneuver) or exercising.

Collagen Injections

Collagen is a naturally occurring protein found in humans and animals. When it is injected into the tissue around the urethra, it adds bulk and helps it close tightly to prevent urine leakage, especially urine leakage associated with activity (Stress Urinary Incontinence). Most patients will leak much less or not leak at all after collagen therapy. Some patients will need to have one or more injections done at a later date because the body will absorb some of the collagen material. The length of time between injections varies with each patient. Some need to be re-injected after a few months and some after a few years.

References:

© John Miklos MD ,Neeraj Kohli, MD