So you’ve told your doctor what your bladder is up to. What happens next?
Firstly, your doctor will want to make a proper diagnosis of your incontinence. They will review all your symptoms, your current medical conditions and what kinds of medication you are on, and do a basic physical exam. You will also need to do a urine test to check for any signs of infection, because bladder infections can be dangerous if left untreated.
Your doctor will ask you questions like ‘what were you doing the last time you had a leak?’, ‘how much did you leak?’, and ‘what were you drinking before the leak?’. This will help them to get an idea of what your triggers are. They may even ask you to keep a bladder diary for a couple of days! (Dear diary…today my bladder decided to misbehave while I jumped on a trampoline…)
Your doctor will give you some advice about management options available, and discuss the various treatment options that may work for you. The different treatments for incontinence can be summarised into lifestyle therapy, behavioural therapy, medication and surgery.
Management options are the products available which can help you to manage your incontinence. Some of the options available are disposable nappies, disposable pads, and reusable absorbent underwear – like Confitex. To learn more about the different management options see here.
This is the first treatment option that your doctor will try. There are many things you can do – try losing some weight if you picked up a few extra pounds from that dastardly Easter Bunny, stop smoking, try increasing the amount of exercise you do, and limit caffeine and alcohol. If you experience incontinence at night or often have to get up during the night to go to the toilet try to avoid drinking liquids after 7pm. The great thing about lifestyle therapy is that the changes you will make will benefit you in many ways other than your bladder leakage as well.
Behavioural therapy entails two different things – bladder and pelvic muscle exercises, and bladder training. For the exercises you will need to practice contracting pelvic floor muscles – your doctor may refer you to a physio or a pelvic floor expert for this. These exercises can really help, but you do need to make sure you follow the schedule you are given and that you are doing them properly and contracting your muscles properly to get the best effect. Bladder training is about creating a regular schedule and retraining your central nervous system to control strong urges. You will need to do things like stopping when you feel an urge, rather than running to the bathroom. Do pelvic muscle contractions and focus on stopping the urgency. This will make the feeling of urgency recede, allowing you time to get to the bathroom. You will also need to create a bladder schedule, where you plan when you will go to the toilet.
Your doctor should only try treating you with medication if you have tried both lifestyle and behavioral therapy and you are still experiencing incontinence. There are many different types of medication available, and these vary between different types of incontinence.
Some of the more common types prescribed include Oxybutynin (Ditropan XL, Oxytrol), Tolterodine (Detrol), Darifenacin (Enablex), Solifenacin (Vesicare), Trospium (Sanctura), and Fesoterodine (Toviaz). All medications have risks and can have side effects, and your doctor should discuss these with you before you start them.
There are many different types of surgery, and your specialist should discuss with you all the different options available for you and the risks and benefits of each. Always make sure you get the full picture before deciding to undergo surgery – if you have the option of a second opinion it can be a good idea to get it!
Some of the different types of surgery are tension-free vaginal tape surgery, retro-pubic suspension, urethral sling, electrical stimulation and urethral bulking.
Lastly, remember that some medications can cause incontinence, and should be avoided if possible.
- Some blood pressure medications
- ACE inhibitors (for heart disease)
- Loop diuretics (for congestive heart failure)
- Cholinesterase inhibitors (for Alzheimer’s Disease)