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One of the most common treatment recommendations for urinary incontinence includes exercising the muscles of the pelvis. These exercises strengthens pelvic floor muscles and sphincter muscles to reduce stress leakage. Patients younger than 60 years old benefit the most. The patient should do at least 24 daily contractions for at least 6 weeks.It is possible to assess pelvic floor muscle strength using a Kegel perineometer.
Increasingly there is evidence of the effectiveness of pelvic floor muscle exercise (PFME) to improve bladder control. For example, urinary incontinence following childbirth can be improved by performing incontinence exercises. Begin incontinence exercises with empty bladder. Start with gravity assisted positioning(hips higher than the heart such as supported bridge or elbows/knees position).
CONTRACT-RELAX TECHNIQUE: Instruct to tighten the pelvic floor muscles as if attempting to stop urine flow or hold back gas. Hold for 3 to 5 seconds and relax for at least the same length of time. Repeat up to 10 times. Watch the patient to encourage normal breathing pattern.
QUICK CONTRACTIONS: Repeat contractions of pelvic floor muscles while maintaining a normal breathing rate and keeping accessory muscles relaxed. Try for 15 to 20 repetitions per set with coughing and sneezing.
ELEVATOR EXERCISES: Instruct the patient to imagine riding in an elevator. As the elevator goes up from one floor to next, contracts the pelvic floor muscles a little more. As strength and awareness improves, add more floors to the sequence of the contraction. Instruct the patient to relax the muscles as if descending one floor at a time.
Studies also report that 50 - 75% of patients who perform only incontinence exercise have a substantial improvement in their symptoms, including elderly people who have had the problem for years. Incontinence exercises may be especially helpful for women in their 40s and 50s who suffer from stress incontinence.
Pelvic Floor Muscle (Kegel) Exercises/Incontinence exercises are designed to strengthen the muscles of the pelvic floor that support the bladder and close the sphincters. The general approach for learning and practicing incontinence exercises is as follows:
Bladder training involves a specific and graduated schedule for increasing the time between urinations:
Some women may use a device called a vaginal cone along with incontinence exercises. The cone is placed into the vagina, and the woman tries to contract the pelvic floor muscles in an effort to hold it in place. The device may be worn for up to 15 minutes. This procedure should be done two times a day. Within 4 - 6 weeks, most women have some improvement in their symptoms.
There are 5 types of urinary incontinence.
Treatment depends on how severe the symptoms are and how much they interfere with your everyday life. The doctor may ask that you stop smoking (if you smoke) and avoid caffeinated beverages (such as soda) and alcohol. You may be asked to keep a urinary diary, recording how many times you urinate during the day and night, and how often urinary leaking occurs.
There are four major categories of treatment for stress incontinence:
Examples of behaviour changes include:
The aim of incontinence exercises is to improve muscle tone by strengthening the pubococcygeus muscles of the pelvic floor. Kegel is a popular prescribed exercise for pregnant women to prepare the pelvic floor for physiological stresses of the later stages of pregnancy and vaginal childbirth. Incontinence exercises are said to be good for treating vaginal prolapse and preventing uterine prolapse in women and for treating prostate pain and swelling resulting from benign prostatic hyperplasia (BPH) and prostatitis in men. Incontinence exercises may be beneficial in treating urinary incontinence in both men and women. Incontinence exercises may also increase sexual gratification and aid in reducing premature ejaculation.
A Kegel exerciser is a medical device designed to be used by women to exercise the pubococcygeus muscle (also called the PC muscle). There are three main types: barbells, springs, and rubber bulbs. Made of smooth, polished solid stainless steel, it is cylindrical in shape, with a rounded bulge at each end. They typically weigh one pound (454g) and measure approximately 6¾ inches (17.1 cm) in length with a diameter of one inch (2.5 cm) at the widest part. Being made of stainless steel, vaginal barbells are nonporous and can be wiped clean with a cloth moistened with mild soap and water.
Spring devices are made of plastic, with removable springs to allow progressive resistance. These allow pressing directly against resistance. An advantage of rubber bulb devices is that they provide visual feedback (via a gauge) of how much pressure is being applied.
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This can stabilize overactive muscles and stimulate contraction of urethral muscles.
Biofeedback uses measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over these muscles.
Treatment sessions usually last 20 minutes and may be done every 1 - 4 days. Newer techniques are being investigated, including one that uses a specially designed electromagnetic chair that causes the pelvic floor muscles to contract when the patient is seated.
Medicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include:
However, whether estrogen treatment improves stress incontinence is controversial. Women with a history of breast or uterine cancer usually should NOT use estrogen therapy for the treatment of stress urinary incontinence.
Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. The less-invasive variants of the sling operation were equally effective in treating stress incontinence as surgical sling operations.One such surgery is urethropexy.
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