Bladder Training. Bladder training involves a specific, graduated schedule for increasing the time between urinations:
- Patients start by planning short intervals between urinations and then gradually progressing with a goal of voiding every 3 to 4 hours.
- If the urge to urinate arises between scheduled voidings, patients should remain in place until the urge subsides. At the time, the patient moves slowly to a bathroom. (In a small study, 73% of women with stress incontinence were helped by an absurdly simple and obvious movement: crossing the legs whenever a cough or sneeze was coming on.)
Vaginal Cones
This system uses a set of weights to improve pelvic floor muscle control. The cones are inexpensive, relatively simple to use, and evidence suggests that they are as effective as Kegel exercises or electrostimulation:
- The typical set includes five cones of graduated weights ranging from 20 grams (less than1 ounce) to 65 grams (slightly over 2 ounces).
- Starting with the lightest, the woman places the cone in her vagina while standing and attempts to prevent the cone from falling out. The muscles used to hold the cone are the same ones needed to improve continence.
As with standard Kegel exercises, frequent repetition is required, but most women will eventually be able to use the heavier weights and build up the ability to prevent stress and urge incontinence.
Biofeedback Devices
Women who are unable to learn Kegel muscle contraction and release with verbal instructions can be helped with the use of biofeedback:
- Biofeedback uses a vaginal or rectal probe inserted by the patient that relays information to monitoring equipment.
- The patient isolates the pelvic floor and bladder muscles and performs Kegel exercises.
- The monitor emits auditory or visual signals that indicate how strongly the patient is contracting the proper pelvic floor muscles and how effectively the bladder muscles are being released.
- The apparatus is designed for home use.
As with any Kegel exercise regimen, biofeedback must be used for several months before it is effective. In one major study, 75% of women with urge incontinence reported satisfaction with biofeedback, although women who were simply given verbal cues were even more satisfied (85%). A 2005 study of older women found that biofeedback worked better than oxybutynin (Ditropan) in controlling nighttime urge incontinence. Biofeedback that teaches control of pelvic muscles even may be very helpful in children who have daytime wetting, frequent urinary tract infections, or both.
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