Incontinence can be successfully treated. In fact 80-90% of the people affected experience significant improvement after treatment. Therefore we would like to advise you again to consult a physician, who can determine the type of inconti-nence and initiate a treatment that is exactly right for you. In the following section, we will explain what you can do in addition to the physician’s measures to make your treatment as effective as possible.
Recognized therapeutic measures for:
Urge incontinence
In urge incontinence, the bladder musculature contracts
“at the wrong time“. An urge to urinate arises resulting in the involuntary loss of urine. Accordingly, the goal of the therapy is to induce the bladder musculature to wait until urination is really necessary and desired.
Two therapeutic measures are commonly used together and have a success rate of over 80%.
1. Medication
2. Urination exercises and a diary
Medication
Different, very effective medications are available which are used to treat a constant urge to urinate. They have a sooth-ing and relaxsooth-ing effect on the bladder, suppresssooth-ing prema-ture contraction and the resulting pressure increase in the bladder. With small doses and modern active agents, side-effects are rarely experienced (for example, dryness of the mouth, constipation, tiredness).
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Urination exercises
You can “accustom“ the bladder to certain voiding times.
By voiding your bladder at fixed times, with specific intervals, it adapts itself exactly to this rhythm and “forgets" the urge between these times. In the side column you see a page from a urination diary that is essential for planning this behav-ioural training. After discussing this with your physician, you can begin your bladder training by going to the toilet during the day exactly every two hours for two weeks. Plan addi-tional trips to the toilet depending on your individual drink-ing and other usual habits – for example, a half an hour after breakfast – but do not exceed a total of ten trips to the toilet per day. Try to observe the fixed times as well as you can, despite the wish to urinate.
Gradually you can increase the intervals between the planned trips to the toilet. You should always go to the toilet at these fixed times even if you do not feel the urge.
Tips on how to control the urge micturition
In the “battle“ against the urge to urinate, it is important to keep in mind that an urge never lasts longer than 5 min-utes: If you can get through these 5 minutes, you will have won! Do not get up to go to the toilet under any circum-stances during the strongest urge because vibrations while walking and heavy breathing while running increase the pressure on the bladder. It is better to sit or stand still.
How is incontinence treated ?
If possible, bend forwards as if you wanted to tie your shoelaces. This frequently helps to ease the urge to urinate immediately. Tense your pelvic floor to avoid a loss of urine. Once the urge to urinate has passed, go to the toilet slowly and keep the pelvic floor closed by constant tensing.
The measures described above, in conjunction with medica-tion, are sufficient for the vast majority of the people af-fected. If these measures are not successful, an electro-stim-ulation treatment may be helpful. In this procedure, electrodes are used to selectively stimulate certain nerves, preventing the bladder musculature from contracting prematurely. Your urge to urinate is completely suppressed.
A more invasive procedure is necessary only in extremely rare cases.
Stress incontinence
If you suffer from stress incontinence, it is essential that you strengthen the musculature of your pelvic floor and sphincter with specific exercises. Usually this pelvic floor training leads to noticeable improvement or complete elimi-nation of the symptoms. In some cases it is required to use medication and behaviour training as well. Treatment is successful in 90% of the cases.
“Emergency posture”
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How is incontinence treated ?
Strengthening the pelvic floor
The supporting musculature in the pelvis is an important el-ement of the closure mechanism of the bladder. Pelvic floor training serves to strengthen these muscles and to rebuild damaged muscle tissue. By doing the exercises properly, you will begin to feel the muscles in the pelvic floor after a short period of time.
It is advisable for you to do your exercises under profes-sional guidance at first.
Vaginal cones and exercise instruments
Vaginal cones can be used to support effective training of the musculature. These small weights shaped like a suppos-itory are inserted into the vagina and held there for a few minutes by contracting the pelvic floor. So-called peri-neometers are also a suitable aid. These are exercise instru-ments that measure the pressure you produce when you tense your pelvic floor, providing you with reliable feedback on your progress.
Biofeedback
This method helps you to perceive your body functions bet-ter. A small probe in the vagina or rectum measures the muscle strength of the pelvic floor electronically and trans-mits this measurement to a computer. This way you can find out if you are exercising the right muscles of the pelvic floor and can see how great the tension is. It is possible to do these specific exercises at home, the necessary instru-ments are covered by health insurance when they are pre-scribed by a physician.
Appropriate exercises are presented in chapter “How can you prevent incontinence?“.
Behaviour training for coping with “stress” situations Make a list of all the situations when you pass urine invol-untarily. These situations are often connected with certain movements or activities, such as coughing or sneezing. The next time you get into a “stress“ situation, tense your pelvic floor before the triggering movement or the triggering pres-sure. Exhale during tensing and try to keep your back as straight as possible, which will help you control your pelvic floor. If you practise this frequently, your pelvic floor will soon contract automatically in these situations.
Medication
If necessary, your physician will prescribe oestrogens or alpha-sympathomimetics which stimulate the musculature of the sphincter.
Operations
In some cases incontinence can only be remedied with the aid of surgery – for example, when the uterus is prolapsed.
Specific pelvic floor training can still be used to ensure the long-term success of the operation and should be started beforehand in preparation.
Pads and incontinence pants
Aids such as pads (for example MoliMed) or incontinence
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How is incontinence treated?
Incontinence pads and all-in-one incontinence briefs have proven to be excellent for meeting the various needs of individuals with incontinence.
Overflow incontinence
In case of overflow incontinence, first of all it is very impor-tant to determine the cause. If the passage is obstructed by an enlarged prostrate or a tumour an operation or proce-dure in the urethra will be required. Medication has proven to be an effective therapy for disorders in the closure sys-tem. They ensure that the smooth muscles of the sphincter relax and allow urine to pass freely.
Reflex incontinence
Bladder tapping training is a method used to stimulate the bladder by tapping or stroking the lower abdominal region at regular, three-hour intervals. This causes the bladder to contract and empty, and helps avoid uncontrolled losses of urine between these periods. Spasmodic contraction of the sphincter during bladder tapping training can be reduced by medication or by a small operative procedure on the sphincter.
Currently the best method for dealing with emptying prob-lems is intermittent auto-catheterism. This involves insert-ing a catheter (thin, flexible plastic tube) into the urethra every three to four hours to empty the bladder completely.
We will inform you about products from HARTMANN in the chapter
“How can you choose the right in-continence product?“.
It is very difficult to restore the function of a reflex bladder.
Paraplegic people are particularly affected by this problem.
Keeping a supply of absorbent incontinence products is always helpful, regardless of the type of incontinence (see chapter “How can you choose the right incontinence product?“).
Extra-urethral incontinence
For this form of incontinence, in which urine attempts to find another passageway through a fistula, the only reliable treatment is an operation.
Alternative methods as accompanying and supportive measures
Reflex zone therapy is regarded as a very successful treat-ment method. Particularly elderly people seem to respond very positively and quickly to these natural therapeutic stimulants. Reflex zone therapy on the feet is considered to be especially helpful. Individual studies document the effi-cacy of hypnosis, acupuncture and homoeopathy as well.
Modern aids for improving the quality of life
To support the therapeutic measures, various modern aids are available which help you continue to take part in a
Important: Consult your physician before you try these alternative therapies to ensure that all the necessary treatment methods used in conventional medicine are included in your treatment plan as well.
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How is incontinence treated?
Condom urinals
Condom urinals can be a suitable option for men. They are made of soft latex and must be fitted appropriately by a nursing staff. The condom may be self-adhesive or fastened with special adhesive strips to the skin. On the lower end of the urinal tube there is an extension for attaching a urine drainage bag. These drainage bags are offered as leg-bags for mobile people and as bed-bags for the night or for bedridden people. The leg-bags can be fastened to the in-side of the calf or the thigh securely and unobtrusively with non-irritating Velcro fasteners or cuffs.
Draining aids
Draining aids are intended for people with severe and very severe incontinence. The physician or trained assistant
inserts a thin plastic tube into the bladder through the ure-thra. This indwelling catheter drains urine continuously from the bladder into a drainage bag that is fastened to the leg of mobile people or to the bed. This indwelling catheter should, however, be used as seldom as possible because in-fections will set in after one month at the latest. The supra-pubic catheter, a thin plastic tube that is directly inserted into the bladder through a puncture in the abdominal wall above the pubic bone (suprapubically), poses a lower risk of infection.
Absorbent aids
Despite effective incontinence treatment methods, the use of absorbent incontinence pads and alll-in-one incontinence briefs or pants is indispensable in many cases. The accept-ance of incontinence pads is especially high among women.
Product improvements, such as thinner, lighter materials have been developed, so that pads can be worn very unob-trusively. Suitably shaped incontinence pads that can be worn comfortably and inconspicuously are also available for men.
These products provide excellent security primarily because of the special absorbent material. This material is able to safely retain even large amounts of fluid, even under pres-sure. In addition the skin stays almost completely dry, pre-venting skin problems and unpleasant odours. Bladder problems, which are caused by the cooling effect of wetness and which can further aggravate incontinence, can also be avoided by using pads.
All-in-one incontinence briefs are available for bedridden people and people with severe incontinence. They are also very suitable if faecal and urinary incontinence exist at the same time. By choosing high-quality products and changing them regularly, your skin will stay virtually dry. This way you
Tip: Do not wear your pad too long despite its high wearing comfort. If you change your pads at regular intervals, you can pre-vent the occurrence of mycotic and other skin infections.
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