Doctor Q&A: What Are Your Treatment Options?
There are numerous treatment options for incontinence patients to consider. Dr. John P. Franz, assistant professor of urology at the University of Pittsburgh School of Medicine, provides answers to questions about incontinence care.
1.One treatment option is behavioral therapies, such as Kegel exercises and bladder training. How do Kegel exercises help? And can you explain what comprises bladder training?
First described by Dr. Arnold Kegel in 1948, Kegels strengthen the muscles that hold up the pelvic floor: the bladder, vagina and rectum. Women have been doing these exercises for centuries—there just wasn't much discussion of them.
Bladder training is the concept that holding in urine can increase bladder capacity. There is some truth to this, but there’s so much variation between individuals that it is difficult to predict the results. A better type of training is to learn not to wait until the last moment before you urinate. Aging seems to bring increased urinary urgency for both men and women, as well as nocturia (getting up at night to urinate). Some people over age 60 actually produce more urine while lying in bed than they do the rest of the day.
2. What are the most common types of external devices used to treat incontinence?
Pads for men and women, and external catheters for men, are the most common types. There is a wide diversity of size and configuration depending on the patient and the severity of the urine loss.
3. Anticholinergics seem to be the main class of drugs used for incontinence. Can you explain how these medications are effective?
Anticholinergics are tranquilizers for the bladder. Anxiety and stress can make us urinate more often, reducing bladder capacity. The connection of the bladder to the brain is critical, and works both to our benefit and our disadvantage.
4. Last year, the FDA approved the use of beta-3 medication for overactive bladder (OAB). Can you explain what this is?
Beta-3 medication has a more specific relaxation effect on the bladder to help increase bladder capacity.
5. Why are most medications primarily used to treat only urge incontinence?
Medications either reduce the urge to void or increase bladder capacity, but they do nothing to strengthen the floor of the pelvis to better support the bladder and its ability to hold urine. Kegel exercises, a pessary (a vaginal device inserted to support the pelvic area), and surgery can do that, so those options are better for other types of incontinence.
6. There are several different surgery options. What advice would you give someone who is considering surgery?
Do the simple things first before considering surgery. Gravity is forever, and sufficient time can degrade surgery with recurrence of leakage. Any surgery has to be tailored to the unique characteristics of the person and, thus, should involve a detailed discussion with the surgeon performing it. Also be aware that procedures will continue to evolve over time.
7. Diet can play a big role in managing incontinence. In what ways should someone with incontinence change his/her diet?
A major concern is obesity. Obesity stresses every part of the body, including overloading the pelvic floor, pushing it down and the urine out. The new diet standards for the United States, "The Plate"—aimed at heart health and preventing diabetes—will help control weight and constipation, both of which aggravate incontinence. This diet is high in fiber, reducing constipation, which causes the kind of pushing that weakens the pelvic floor. Obesity and aging raise the risk of diabetes, thereby increasing the chance of incontinence and urine infections.
8. Any other lifestyle changes you'd recommend?
Regular exercise, walking, or pool exercises help general strength, well-being, and posture—all of which improve incontinence. Good strength makes it easier to get to the toilet without having to exert so hard that the urine is just forced out. Also, stop smoking if you do.
9. Will there be any new incontinence treatment options in the near future?
There has been a continued interest in injections into the urethra or pelvic floor tissues to tighten the urethral sphincter. There is also research being done on injecting stem cells to increase the muscles that hold in the urine.
10. What can people do to help their doctor treat them most effectively?
Learn, be informed, ask questions, and do your part. A great resource to explore is urologyhealth.org. Diligence is fundamental to self-care. Ignorance is the ultimate illness.