Urinary incontinence treatment — what you can do right now
Bladder issues are like so many health-related concerns — the sooner you attend to them the easier they are to treat. So here’s what you can do:
See your healthcare provider. If you are noticing any urine leakage or an increased frequency of urination, the first step is to get checked out by your healthcare practitioner. Depending upon the situation, you may find it useful to consult further with a gynecologist, urogynecologist, or urologist.
When we see women for bladder problems, we first try to figure out what kind of urinary incontinence they are dealing with. Most often this is some form of mixed incontinence that can be treated through alternative therapies.
Pelvic floor exercises. In cultures where women squat to do their work, there is a much lower incidence of incontinence. Most women don’t do much in the way of that kind of labor anymore — but we’ve got Kegel exercises! Incontinence can often be arrested or reversed with Kegel exercises alone. Named after an American ob/gyn, these simple exercises are really an adaptation of the “root lock” of kundalini yoga without the trappings. You can do them anywhere, anytime — and you should.
To do a Kegel, imagine that you are trying to stop yourself from urinating. Practice both short and long Kegels. You can even do an anticipatory Kegel before you sneeze or cough and prevent leakage! For more information on Kegel exercises for urinary incontinence, visit the University of Iowa Hospital and Clinics’ website.
A wonderful added benefit of Kegels is that the increased muscle tone can increase sexual pleasure in both sensation and orgasm. Male partners are happier too!
Sometimes women have trouble identifying the muscles that control the bladder and get frustrated attempting Kegels. This can be a natural result of conditioning the brain to ignore bladder stimulation. How many of us are too busy to go to the bathroom when we feel the urge, then “forget” we had to go. Over time, it’s possible that our brain just stops paying attention and we disconnect. It can take some work to get those pathways talking again.
If Kegel exercises don’t seem to be working well for you, you can try insertable cones or balls (available through your doctor or on the internet) to help you train your PC (pubococcygeal) muscle. Biofeedback practitioners use electronic monitors inside the vagina to help women learn how to identify and tone muscles related to the bladder. Both tools can be very effective.
Any kind of physical exercise that engages your core will help strengthen your pelvic muscles, but Pilates and yoga in particular are great inner toners. Both focus on building a firm core or root. They also use deep breathing and mindful movement to reconnect the brain to the body.
Acupuncture is another method that has provided symptomic relief for some women. It helps tone muscle and increase blood flow to the bladder. It can boost the immune system, soothe inflammation, and restore balance to the hormones.
Pelvic physical therapy (PPT) is sometimes effective in difficult cases. Practitioners use several diagnostic tools, including sonograms, physical exams and lower back screenings to evaluate the cause of incontinence. Treatment may include external and internal pelvic floor massage, relaxation training, biofeedback, strengthening, bladder retraining, and home exercises. This is especially useful when patients have adhesions or physical anomalies due to radiation treatment, injury or surgery. Many women who undergo PPT report increased libido and enjoyment of sex in addition to better bladder control.
Nutrition is vital to restoring a healthy balance to your endocrine and immune system, which in turn is important for maintaining muscle tone and preventing infection. Eating a diet of whole foods with plenty of fruits, vegetables, protein and some whole grains will promote adequate nutrition and help level out your hormones. Be sure to take a robust multivitamin/multimineral formula to support your body. And try supplements with cranberry extract — just be sure they don’t have added sugar.
Allergies may exacerbate an overactive bladder. If you think you may have food allergies or sensitivities, we recommend trying an elimination diet (avoiding a suspicious food for two weeks, then re-introducing it for a day or two).
Drink plenty of water and herbal tea. Flushing your urinary tract regularly will help evacuate bacteria. Cranberry juice and extracts can help prevent urinary tract infections by changing the pH of the bladder, but again, be sure you choose one with no added sugars. (Excess simple carbohydrates in the diet only encourage UTI’s). If you are getting up in the middle of the night to urinate, stop drinking a few hours before bed.
Internal or surgical methods. If you’ve tried everything and you still can’t go out for an evening without worrying, you may want to consider a form of internal intervention. If urinary incontinence is keeping you from fully enjoying your work, love life, hobbies and pursuits, then fitted internal devices or surgical interventions are a reasonable next step.
Fitted pessaries, sometimes referred to as prolapse pessaries, are removable umbrella-like support rings that can help lift your pelvic organs up off your bladder. A pessary can be a great non-invasive choice for a woman with a cystocele or uterine prolapse.
New techniques like bladder laparoscopy and bladder slings can be helpful for treating severe stress incontinence in some women. Currently the most common procedures are known as the Burch colposuspension technique and the fascial sling. In the past, bladder suspension surgeries had a useful life of about four years. In the Burch, the urethra and bladder are secured with sutures to the pelvic wall. The new bladder slings use life-like materials that move with the body and act like real muscle.
Unfortunately, however, a study published recently in the New England Journal of Medicine suggests that neither of these surgical procedure offers terrific results for the women who have them. Known as the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr), the fascial sling was compared with the Burch colposuspension technique for treating stress urinary incontinence — the type of leaking that can occur when we run, laugh, sneeze, cough, or lift heavy objects. A mere two years following surgery, only 47% of the sling patients and 38% of the Burch suspension patients experienced good resolution of their stress urinary incontinence. Even so, the better results of the sling appeared to be offset by higher rates of UTI’s, problems with voiding, and even urge incontinence.
As with any surgery, we recommend getting as much information as possible and discussing your options with a few practitioners. More progressive doctors are using the latest technology to re-engineer a leaky bladder without excessive trauma and scarring. There are now gynecologists who specialize in urology (urogynecologists), and more women are going into urological surgery (formerly an exclusively male specialty). It’s safe to say that the more experience a surgeon has with a procedure, the more likely it is that you will experience the results you are looking for.
Emotional work. Understanding our hidden fears and anger or reluctance to “let go” can be a powerful remedy in dealing with incontinence. Many women have found relief with the Feldenkrais method — a mind-body technique that can help heal physical conditions through the release of emotional blockages with movement.
Because the brain and the bladder are intimately connected, it only makes sense to approach incontinence on both fronts.