Urinary Incontinence

Tamara Dickinson, RN, CURN, CCCN, BCIA-PMDB

My prescription for urinary incontinence helped but I’m still having problems. What other options do I have? Lifestyle changes? Exercises? Surgery?

Today there are many effective treatments for the properly evaluated and diagnosed patient. These treatments vary greatly and do not always mean surgery. Consuming adequate fluids is important. Too few fluids can cause bladder irritation due to concentrated urine, while taking in too much can cause an increase in frequency.

Decreasing the intake of known bladder irritants can also decrease urgency and frequency. These irritants include caffeine, carbonated beverages, alcohol, citrus fruits and juices, spicy foods, tomato-based products and artificial sweeteners. Managing constipation can have a significant impact on urinary symptoms, though they may not seem related.

Bladder retraining teaches you to resist the sensation of urgency and postpone voiding to help manage overactive bladder. Pelvic muscle exercise (or Kegel exercise) programs can also be very effective in managing urinary symptoms. Today, pelvic muscle training has grown into a complex therapy involving highly trained health care providers teaching behavior modification and the appropriate use of these pelvic floor muscle exercises.

Medications called anti-cholinergics or anti-muscarinics are effective in the management of overactive bladder and urge urinary incontinence. If these medications and a pelvic muscle exercise program do not improve, sacral nerve stimulation may be the next step. This type of neuromodulation almost functions as a "pacemaker" for the bladder by delivering stimulation to the nerves that control the bladder.

Unfortunately, limited medication options are available for stress urinary incontinence and surgical therapy is considered the gold standard for treatment. The aim of this surgical intervention is to reposition the urethra or to create a backboard of support to stabilize it. Minimally invasive techniques have been developed as well as bulking agents that are injected to squeeze shut the bladder outlet.

Tamara Dickinson, RN, CURN, CCCN, BCIA-PMDB
President, Society of Urologic Nurses and Associates
www.suna.org