Urinary Incontinence Treatment Options

Pelvic floor relaxation and urinary incontinence is a serious problem that affects 1 in 3 women.  Depending on genetics, some women notice urinary incontinence as early as in their early 20s. Almost half of women who suffer from urinary problems say that their symptoms significantly affect sexual function and their relationships with their partners.  Women who are athletic and high functioning, as well as women who have experienced pregnancy and childbirth, are more likely to have urinary incontinence.  

Traditionally, Gynecologists and Urologists have relied upon Kegel exercises, Pelvic floor rehabilitation, oral medications, and surgery to treat urinary incontinence and pelvic floor conditions.  Recently, noninvasive office procedures utilizing Laser, Radiofrequency, Electromagnetic, and High-Frequency Ultrasonic energy have become available and have great potential in alleviating and improving symptoms.  In this article, we will discuss the treatment options available and their pros and cons.

1. Lifestyle modification
2. Mediations
3. Kegel exercises and pelvic floor rehabilitation
4. Laser and radiofrequency treatments
5. Surgical intervention

Lifestyle Modification

Mild urinary incontinence can be improved by changing personal habits.  Patients are advised to urinate frequently, every 2- 4 hours and also to double void.  Double void means urinating twice each time. That means you wait after seconds after voiding and then try to void again to make sure your bladder is completely empty.  It is helpful to also train your bladder to be able to hold urine a little by trying to wait 10 minutes, then 15, to 20 minutes from the time you feel the urge to urinate before actually using the bathroom.  Continue to do this until you are able to space bathroom breaks by 2 to 4 hours. Lastly, you should avoid caffeine, alcohol, and citrus rich foods.

Medications

There are medications that can help with urinary incontinence such as Detrol,  Ditropan, Vesicare, Enablex, Toviaz, and Myrbetriq. These medications work by relaxing the bladder muscles and allowing it to hold more urine.  This enables longer intervals between bathroom breaks. While generally tolerated, common side effects of these medications are dry mouth, constipation, drowsiness, headaches, and nausea.   

Kegel Exercises

Pelvic floor muscle exercise can help build, strengthen and improve urinary symptoms in women.  Kegel exercises while known to be effective is underutilized in managing urinary incontinence. To perform Kegel exercises effectively, squeeze your pelvic floor muscles the same way you hold or stop your urine midstream.  Try to hold this for 5 seconds and relax. Repeat 150 times and do this 3 times daily for optimal results. The biggest hurdle to doing Kegel exercises is first forming a habit. To make it easier to remember, try doing Kegels during your breakfast, lunch, and dinner or pair it with something you do regularly on a daily basis.  Some people need help isolating the right pelvic floor muscles and hence may need the assistance of a pelvic floor rehabilitation specialist (Physical therapist). Also, patients who have moderate to severe pelvic floor relaxation may need further assistance even if they are diligently doing Kegel exercises. Biofeedback and specialized pelvic floor training and improve urinary incontinence and pelvic floor prolapse and can help delay or avoid the need for surgical intervention.

Laser, and Radiofrequency procedures

There is a myriad of devices used to treat pelvic floor and intimate health conditions.  These include Mona Lisa®, Thermivia®, Votiva®, and a host of others. These devices are used by clinicians to induce collagen production.  The idea of College induction to improve vaginal tissue is not a new concept. Estrogen creams have been used successfully to induce collagen production and improve mild to moderate urinary incontinence and intimate health problems. While these devices are minimally invasive, they are not without risk and complications can occur if not used carefully and properly.  Insurance companies do not cover these procedures as they are currently considered cosmetic and elective. It is important to choose a physician who understands women’s intimate health and well versed in examining and treating women to ensure safe and proper treatment.  
At En Santé Clinic and Medical Spa, we choose to use the Viveve system.  Viveve® is a radiofrequency device that cools the vaginal mucosa while delivering radiofrequency energy deeper into the tissue to induce collagen production.  The procedure takes about 30 – 45 minutes to perform in the doctor’s office and only one treatment is needed to induce collagen growth. As we age each year our bodies’ ability to make elastin and collagen continue to diminish and hence touch up or maintenance procedure is needed to induce more collagen production.

Surgical intervention

Surgical intervention, while effective in treating urinary incontinence, pelvic floor prolapse and women’s intimate health problems, should be a delay as long as possible because as we age, our bodies make less and less collagen and elastin and so the benefits from a tightening procedure, sling or pelvic floor suspension may diminish and additional surgical intervention may be needed.  Revision surgeries are more difficult to perform due to scar tissue formation. For patients who desire or need to have surgery, it is advisable to continue with some form of maintenance treatment that produces continued collagen induction such as estrogen cream.