TREATING URINARY INCONTINENCE
Luckily, there are many different ways of effectively treating or managing urinary incontinence. As a caregiver, you won’t be responsible for deciding which method should be used but you may, however, be asked to assist with a treatment plan. These treatment methods include:
Kegel or “pelvic floor muscles” exercises are done to strengthen the muscles that help control the passing of urine. Women of all ages can learn to perform Kegel exercises to reduce or even cure stress incontinence. To locate the muscles to exercise, the person can stop and start the flow of urine when going to the bathroom. Once she understands which muscles control the passing of urine (voiding), she simply tightens and relaxes these muscles over and over.
There are many ways to perform Kegel exercises. One way is to squeeze the muscles slowly together for a few seconds and then relax them for a few seconds about 10 times several times a day. A healthcare professional should teach the person in your care how to do the exercises. She can also instruct her on how often to do them.
Vaginal cones are sometimes used with Kegel exercises. These are small weights that are placed within the vagina for short periods of time. Vaginal cones help to strengthen the muscles around the vagina.
Brief, small doses of electrical stimulation can help to strengthen the muscles that control the flow of urine. Electrical stimulation is used to treat both stress and urge incontinence. Electrodes are placed in the vagina or rectum to stimulate the involved muscles. Most people do not feel any pain during this procedure. They may feel tingling or a tightening of the pelvic floor muscles.
Biofeedback is used along with Kegel exercises and electrical stimulation to treat stress and urge incontinence in women. Biofeedback uses measuring equipment to help the person become aware of how her body functions and to gain control over bladder and pelvic muscles.
Habit training can be helpful for people with functional incontinence. It can only be used when a normal pattern of voiding can be established. It involves taking the person to the bathroom according to the normal routine followed before the incontinence started. For example, if the person normally went to the bathroom before meals and in the middle of the morning, he or she should be taken to the bathroom at those times so that the “normal” habits are restored.
To void means to urinate or pass your water. Timed voiding means that the person empties his/her bladder at specific times, often every two to four hours. This technique helps to reduce or stop incontinence and leaking. Healthcare workers caring for the elderly often follow a scheduled toileting program for certain clients who are bedridden or very frail.
Timed voiding is used with bladder retraining but the length of time between trips to the bathroom is slowly increased. In this way, the bladder trains to delay voiding for longer periods of time. This technique is sometimes used with urge and mixed incontinence.
Keeping a record
When retraining the bladder, it is helpful (and important) to keep track of information such as when the person empties his/her bladder, when incontinence occurs, and what he or she was doing when the incontinence occurred. This type of record can determine a pattern in voiding and incontinence. It can then be used to plan when to go to the bathroom to avoid being incontinent and to establish a “normal” pattern of voiding.
Medications can help to reduce incontinence. Some medications can help to relax bladder muscles. Others work in different ways to control the problem. It may take several weeks before the person notices an improvement from the medications.=
A pessary is a stiff ring that is placed in the vagina. It presses against the wall of the vagina and the opening of the bladder. This pressure helps to lessen stress leakage. People using this device must look for possible vaginal and bladder infections and see their doctor on a regular basis.
Implants are substances that are injected into tissues around the bladder opening. These substances help to close the bladder opening and reduce stress incontinence. The injections must be repeated every so often because they do not last forever.
Surgery is usually used only after other treatments to reduce incontinence have been tried and have failed. Many surgical procedures have high rates of success. Some common operations to assist women with stress incontinence involve lifting the neck of the bladder to help it stay closed or supporting the bladder to prevent leakage during pressure increases.
If the person in your care needs surgery, he or she should get all their questions answered before they have the surgery. A few of the issues they may want to find out about are: What exactly will be done during the operation? How long will it take to recover? When will I be able to return to work? What improvements can I expect and will these improvements last? What are the possible complications of this operation? Are they dangerous? Advise the person to write down his questions along with the answers the doctor gives him so he won’t forget.
USE OF CATHETERS
Sometimes a catheter is used to empty the bladder. This is a tube that is placed inside the bladder. It connects to a heavy plastic bag that attaches to the leg. The bag must be emptied of urine several times a day. A larger bag may be needed at night. This type of catheter is called an indwelling catheter or Foley catheter. An indwelling catheter may be left in place for days or even weeks. It needs to be changed by a healthcare professional every so often. In other words, a new tube will be placed inside the bladder and the old tube will be removed and thrown away.
If the person in your care has a chronic disorder such as a spinal cord injury, he or she may learn to do self-catheterization. In this case, the person places a catheter inside the bladder several times a day to empty it of urine. After the bladder is empty, the tube is removed right away.
Men with this condition may use a soft sleeve or condom that fits over the penis to collect urine. It may be called an external catheter, a penile sheath, or a condom catheter. It attaches to a leg drainage bag. It can be used during the day, at night, or left on for about 24 hours. Most of these devices can only be used once.