![]() Muscle contraction and relaxation to reduce incontinence by producing urethral closure and decreasing central nervous system stimulation of detrusor muscle Urge incontinence in patients with cognitive impairmentĬheck for wetness at intervals to determine when the patient urinatesīring the patient to the toilet, or provide commode or bedpan at intervals slightly shorter than the patient's normal voiding interval Individualized toileting scheduled to preempt involuntary voiding Urge incontinence in patients without cognitive impairmentĬoncentrate on decreasing the sense of urgency through rapid successive pelvic muscle contractions, mental distraction (e.g., mathematical problem solving), and relaxation techniques (e.g., deep breathing)Īfter controlling the sense of urgency, walk slowly to the bathroom and voidĪfter mastering this, attempt to extend the time that urination can be postponed aim to extend the interval by 30 to 60 minutesĬontinue this process until voiding occurs every three to four hours without incontinence Retrain pelvic mechanisms and the central nervous system to inhibit urge sensation between voids ![]() Periurethral injections of bulking agentsĬombination of above treatments with focus on dominant symptomsĪlpha-adrenergic antagonists or blockers (e.g., tamsulosin ) Retropubic urethropexy or colposuspension (i.e., Burch and Marshal-Marchetti-Krantz procedures) Suburethral sling with tension-free vaginal tape Mechanical devices (e.g., pessary, urethral plugs)Īlpha-adrenergic agonists (e.g., pseudoephedrine, phenylephrine) * Pelvic floor muscle exercises (alone or with manual or biofeedback) Neuromodulation (implanted sacral nerve stimulator) More often occurs in patients with arthritis, gait disturbance, or dementiaĮlectrical stimulation of the posterior tibial nerveīeta-adrenergic agonists (mirabegron ) Loss of urine associated with inability to toilet because of impaired cognitive, psychological, or physical function More often occurs because of neurologic disordersĬognitive, mobility, or psychological impairment Impaired detrusor contractility from neurologic disorders, including diabetic neuropathyĭribbling and/or continuous leakage associated with incomplete bladder emptyingīladder outlet obstruction is uncommon in women Loss of urine with physical exertion or increases in intra-abdominal pressure (e.g., sneezing, coughing, laughing) Loss of urine accompanied or preceded by strong desire to void may be accompanied by frequency and nocturia Surgical interventions, such as sling and urethropexy procedures, should be reserved for stress incontinence that has not responded to other treatments. Minimally invasive procedures, including radiofrequency denaturation of the urethra and injection of periurethral bulking agents, can be used if stress incontinence does not respond to less invasive treatments. Food and Drug Administration for this condition. Limited or conflicting evidence exists for the use of medications for stress incontinence no medications are approved by the U.S. Alternatives for treating stress incontinence include vaginal inserts, such as pessaries, and urethral plugs. Noninvasive electrical and magnetic stimulation devices are also available. Pelvic floor muscle exercises are considered first-line treatment for stress incontinence. Sacral nerve stimulators, which are surgically implanted, have also been shown to improve symptoms of urge incontinence. Other medication options for urge incontinence include mirabegron and onabotulinumtoxinA. Pharmacologic therapy with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful however, because of adverse effects, these agents are not recommended in older adults. Neuromodulation devices, such as posterior tibial nerve stimulators, are an option for urge incontinence that does not respond to behavioral therapy. Bladder retraining and pelvic floor muscle exercises are first-line treatments for persons without cognitive impairment who present with urge incontinence. A stepped-care approach that advances from least invasive (behavioral modification) to more invasive (surgery) interventions is recommended. Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed.
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