Incontinence

Kegel exercises don’t require special clothing or equipment. They’re easy to learn and simple to do. And if you do them right, no one can tell you’re doing them, so they can be done almost anywhere. Your doctor, nurse, or physical therapist can answer any questions you have and help you get started.

A Weak Pelvic Floor

The pelvic floor muscles may weaken due to aging, pregnancy and vaginal childbirth, injury, surgery, chronic cough, or lack of exercise. If the pelvic floor is weak, your bladder and other pelvic organs may sag out of place. The urethra may also open too easily and allow urine to leak out. Kegel exercises can help you strengthen your pelvic floor muscles so they can better support the pelvic organs and control urine flow.

How Kegel Exercises Are Done

Try each of the Kegel exercises described below. When you’re doing them, try not to move your leg, buttock, or stomach muscles.

• While you’re urinating, try to stop the flow of urine. Start and stop it as often as you can.
• Contract as if you were stopping your urine stream, but do it when you’re not urinating.
• Tighten your rectum as if trying not to pass gas. Contract your anus, but don’t move your buttocks.

Try to hold each Kegel for a slow count to five. You probably won’t be able to hold them for that long at first, but keep practicing. It will get easier as your pelvic floor gets stronger. Eventually, special weights that you place in your vagina may be recommended to help make your Kegels even more effective.

Helpful Hints

• Do your Kegels as often as you can. The more you do them, the faster you’ll feel the results.
• Pick an activity you do often as a reminder. For instance, do your Kegels every time you sit down.
• Tighten your pelvic floor before you sneeze, get up from a chair, cough, laugh, or lift. This protects your pelvic floor from injury and can help prevent urine leakage.

The best treatment for you will depend on the type of incontinence you have. Your symptoms, age, and any underlying problems that are found also affect your treatment.

How Lifestyle Changes May Help

• Quitting smoking. Smoking can lead to a chronic cough that strains pelvic floor muscles. Smoking may also damage the bladder and urethra.
• Losing weight. Excess weight puts extra pressure on the pelvic floor muscles. Exercising and eating right can help you lose weight. This helps other treatments work better.
• Making certain diet changes. Some foods may make you need to urinate more, so it may be good to avoid them. These include caffeinated drinks and alcohol. Ask your doctor whether these or other diet changes might be helpful.

How Kegel Exercises Can Help

Kegel exercises help strengthen the pelvic floor muscles. The pelvic floor muscles act as a sling to help hold the bladder and urethra in place. These muscles also help keep the urethra closed. Weak pelvic floor muscles may allow urine to leak. To strengthen the pelvic floor muscles, do Kegel exercises daily. In a few months, the muscles will be stronger and tighter. This can help prevent urine leakage.

In some cases, medication can help improve or relieve incontinence. Most of the time, medication is given mainly for urge incontinence. But medication may also help some cases of stress incontinence. Your doctor can discuss your options with you. Know how to take your medication correctly. Also know what side effects to expect.

Medication for Incontinence

Below are some types of medications that may help treat incontinence.

• Anticholinergics may increase the amount of urine the bladder can hold. They may also help relax bladder muscles.
• Alpha-adrenergics may help tighten the bladder neck and urethra.
• Estrogen may help improve muscle tone in the urethra and bladder.
• Antibiotics can treat a urinary tract infection if one is present.

Tips for Taking Medication

• Take your medication on time and as your doctor has instructed.
• Ask what side effects to expect with your medication. Tell your doctor if you have any side effects. Your doctor may be able to minimize side effects by adjusting your dosage.
• Be patient. Some adjustments may be needed before the right dose is found for you.
• Keep a list of the medications you take. Show the list to any doctor you visit for treatment. Also show it to the pharmacist before you buy any over-the-counter medications. Some over-the-counter medications can make incontinence medication less effective. Certain medications may also make incontinence worse.

You and your doctor can discuss other ways to manage your incontinence. These may be used with or instead of other treatments. Your doctor may teach you ways to “train” your bladder.

Timed Voiding

Timed voiding means urinating on a set schedule. This empties the bladder and helps avoid accidents. Visit the bathroom at the scheduled time-don’t wait until you have the urge to urinate. Your doctor can suggest how often you should urinate.

Bladder Retraining

If you have urge incontinence, you may be used to going to the bathroom very often. To help “retrain” your bladder, your doctor may suggest using Kegel exercises. Each time you feel the urge to urinate, try to stop the feeling by contracting your pelvic floor muscles. Try to hold your urine a little longer each time. Your doctor can give you a goal to work up to. Note that this treatment should never be used in children.

Self-Catheterization

Catheterization uses a thin tube (catheter) to drain urine from the bladder. The catheter is inserted through the urethra into the bladder. You may be asked to perform self-catheterization. Regularly draining your bladder of urine can help control overflow incontinence. The procedure is painless and easy to learn. If this treatment will help you, your health care provider will teach you the process.

The best treatment for you will depend on the type of incontinence you have. Your symptoms, age, and any underlying problems that are found also affect your treatment.

Biofeedback

This is a technique that can help you learn pelvic floor muscle exercises. A special tampon-shaped sensor is placed in your vagina or rectum. A flat sensor is placed on your stomach. When you contract or relax, your muscles give off signals. The sensors read these signals and show them on a computer screen. A nurse or physical therapist helps you read the signals. This way, you can learn whether you are exercising the right muscles. During biofeedback, a sensor is placed in your vagina (and another is placed on your abdomen) to read signals from your pelvic floor muscles.

Electrical Stimulation

This painless therapy is used for people with very weak or damaged pelvic floor muscles. It uses specialized equipment, which can include sensors or a special chair. A tiny amount of electric current is sent through the muscles of your pelvic floor and bladder to make the muscles contract. This helps the muscles get stronger.

Stimulator Implants

For urge incontinence, a small stimulator device can be implanted under the skin near the stomach. This device gives off mild electrical signals. This blocks extra signals to the bladder muscle and helps the bladder work more normally.

Urethralimplants are one method to help treat incontinence due to a weak sphincter. Implanting (injecting) a bulking agent into your urethra may help close the sphincter and restore most or all of your control over urine flow. These implants may be made of synthetic materials or collagen, which is a protein naturally found in the body of animals and humans. Urethral implants are usually done in the hospital on an outpatient basis.

Your Experience

• To keep you from feeling pain during the procedure, your urethra and bladder area may be numbed (local anesthesia), your body below the waist may be numbed (regional anesthesia), or you may be completely asleep (general anesthesia).
• The doctor inserts a cystoscope (a thin, tubelike telescope) into your urethra. This instrument lets the doctor see the inside of your urethra.
• A needle is inserted (either through the cystoscope or along the outside of your urethra) into the sphincter area.
• The doctor injects a bulking agent through this needle into the wall of the urethra. The injections make the tissue close up, which stops urine from leaking out of the bladder. When you try to urinate, the tissue separates naturally to allow urine to flow.

Possible Complications (Rare)

• Temporary or permanent worsening of incontinence.
• Infection of the bladder or urethra.
• Pain or discomfort at the injection site.
• Inability to urinate (urinary retention).
• Allergic reaction to collagen.

When to Call Your Doctor

Call your doctor if you experience any of the following symptoms after your implant procedure:

• Bleeding.
• Problems urinating.
• Signs of infection (fever over 101.0°F, chills, frequent urination, urgent urination).

When you’re incontinent, you can’t always control the release of urine. You may leak urine. Or you may not be able to “hold” your urine when you can’t get to a bathroom. This happens because certain parts of the urinary system are not working right.

Stress Incontinence

If you have stress incontinence, urine leaks out of the bladder during activity. Stress incontinence may occur temporarily in men after prostate surgery. It may also occur because the sphincter muscle is weak. Symptoms of stress incontinence include leakage when you cough, sneeze, laugh, or lift something heavy.

Urge Incontinence

If you have urge incontinence, your bladder feels full and pushes urine out, even when it’s almost empty. An infection in your urinary tract, a nerve problem, surgery, or a growth in the bladder may be the cause. The main symptom is a frequent, sudden, uncontrollable urge to urinate. Urge incontinence is often referred to as an “overactive bladder.”

Overflow Incontinence

If you have overflow incontinence, the bladder doesn’t empty normally and becomes very full. Urine may dribble out of the bladder frequently in small amounts. It may happen if something blocks the bladder opening or the urethra, or if nerve or muscle problems keep the bladder from contracting. You may need to urinate often, and your urine may trickle instead of flowing freely. The bladder may also never feel completely empty.

Mixed Incontinence

If you have mixed incontinence, you have more than one type of incontinence occurring at the same time.

Based on your evaluation, you and your healthcare provider can discuss ways to manage your incontinence.

Healing After Prostate Surgery

Incontinence can occur after surgery on the prostate gland. Most often, the incontinence clears up when healing is complete. Very rarely, prostate surgery may result in permanent incontinence.

Medications

Your healthcare provider may prescribe medication to help control your incontinence. He or she will describe how it works and any side effects it might have.

Medications may:

• Help the sphincter work better to stay closed and not let urine leak out.
• Help stop the bladder from contracting too often to push urine out.
• Help the bladder muscles contract with more force, or help relax the sphincter muscle and allow urine to flow.

If a urinary tract infection is the cause of your incontinence, antibiotics can clear up the infection.

Behavioral Changes

Your healthcare provider may recommend certain changes in your daily routine to help control your incontinence. These changes may include:

• Avoiding substances such as caffeine and alcohol (which can increase urination).
• Following a schedule for drinking fluids and urinating (timed voiding).
• Changing certain medications that you take if necessary.

Your healthcare provider may also recommend Kegel exercises. These exercises involve regularly tightening the muscles in your sphincter and around your bladder to help strengthen them. Your doctor can explain how these exercises are done.

Catheters

A catheter is a narrow tube that is inserted through the urethra into the bladder to help drain urine. A condom cathetercovers the penis to channel urine into a collection bag. Intermittent catheterization is when a catheter is inserted, used to drain the bladder, and removed on a regular schedule. This is often done by incontinent persons themselves, a procedure called self-catheterization.

Surgery

Certain surgeries are available to treat some cases of incontinence. Surgery may be done to remove a blockage or implant an artificial sphincter. For stress urinary incontinence, sling procedures, which create support for the urethra, are sometimes used. If surgery is an option for you, your healthcare provider can discuss the specific procedure with you and explain its risks and benefits.

Do you sometimes leak urine when you cough or sneeze? If so, your doctor may have told you that you have stress urinary incontinence (SUI). Stress urinary incontinence may occur when the structures that help hold urine in your bladder become weak.

The Symptoms of SUI

If you have SUI, you may leak urine when you:

• Exercise.
• Get up from a bed or chair.
• Cough, sneeze, or laugh.
• Lift something heavy.

Normal Urine Control

The bladder holds urine until you are ready to let it flow out. These structures help:

• The pelvic floor muscles and connective tissue help hold the pelvic organs in place. When the muscles and connective tissue are strong, the urethra and bladder are well supported. This helps keep the urethra closed, so urine doesn’t leak. Strong pelvic floor muscles and connective tissue, and a strong urethral sphincter, help keep urine in the bladder.
• The urethral sphincter is a band of muscles around the urethra. When these muscles are strong, they keep urine in the bladder. These muscles relax when you want urine to flow out.

If Urine Leaks Out

The pelvic floor muscles and connective tissue may stretch, weaken, or tear. Weak or torn structures can’t support the urethra and bladder. The urethral sphincter may also weaken. These changes can cause urine to leak. Weak or torn pelvic floor muscles and connective tissue, or a weak urethral sphincter, can let urine leak out of the bladder. The changes may be caused by:

• Pregnancy and vaginal childbirth.
• Constant coughing (such as with bronchitis).
• Being overweight.
• Aging.

When the surgery is done, you’ll go to the PACU (postanesthesia care unit). It is also called the recovery room. You’ll stay in the PACU until you’re fully awake. This is often a few hours. You’ll then go to a regular room. Your hospital stay may last from 1-3 days.

In the PACU

When you first wake up, you may feel groggy, shaky, or cold. The surgery may make it hard for you to urinate. This may last for a few days or even a few weeks. You may have a small tube (catheter) in your bladder to help it drain. One kind of catheter, called a Foley catheter, may be put into your bladder through the urethra. Or, a suprapubic catheter may be placed in the bladder through a small incision in the lower abdomen. It is normal for your urine to have some blood in it after surgery. Other tubes may help drain blood and fluid from your incision. IV lines give you fluids, nutrition, and medications. If you have a vaginal incision, you may have gauze packing in the vagina for 24 hours.

In Your Hospital Room

Once you’ve been moved to a regular room, family and friends can visit you. The IV lines and catheter will remain in place for a while. Healthcare providers will check on you. As your intestines may take a day or so to recover, you may have gas pains. To help your intestines recover, it may be 24 hours before you are given any food to eat.

Managing Pain

To control pain from the surgery, the nurse may give you medication. Or, you may have a PCA (patient-controlled analgesia) pump, which is attached to an IV line. This pump lets you give yourself pain medication. It is normal to feel some pain at first. But if the pain bothers you, tell your nurse right away. Don’t wait until the pain gets bad before you mention it.

Getting Up and Walking

The day after surgery, you may be helped to get up and walk. At first, you may not walk far. But walking keeps your blood moving and helps prevent blood clots. Once you can get out of bed, you may be helped to the bathroom to see if you can urinate. You may still notice some blood in your urine. This should go away in a few days. Once you can stand on your own, you may be able to take a shower.

Your Catheter

If you have a catheter, it may be removed before you leave the hospital. In some cases, it may need to stay in your bladder for a few more days. If you are sent home with a catheter, you will be shown how to care for it.

Going Home

Your healthcare provider will let you know when you can leave the hospital. Have an adult friend or family member drive you home. Take care of yourself at home as instructed. Be sure to schedule any needed follow-up visits with your doctor.