Diagnosis and Treatment Options
The first step in getting a diagnosis is to make an appointment with your doctor, nurse practitioner or physician’s assistant. You may be embarrassed by having to talk about your bladder control problems, but don’t worry, your health care clinician is there to help you.
Preparing for Your Visit
It will be helpful for you to take the following information with you for your visit. These include
- List of medications you are taking, including over the counter (like antacids, laxatives, asprin) and herbal
- Previous surgeries
- Number of pregnancies and childbirth, any delivery problems (tearing or episiotomy)
- List of fluids and amount you drink including water, regular or decaf coffee or tea, citrus juices, sodas or diet, alcohol, use of aspartame (Equal™) and also, chocolate (drinks or candy)
- Bladder diary if you have kept one (24-hour record of liquids consumed, urination, and leaks, with times of each).
If your health care clinician is not experienced in treating urinary incontinence, ask for a referral to someone who has expertise in treating female urinary incontinence (gynecologist, urogynecologist or urologist who treats female incontinence).
Physical Exam
A physical exam may include, but is not limited to, the following:
- Checking your reflexes to look for nerve damage.
- A urine sample for a urinalysis to detect urinary tract infection (UTI).
- A pelvic exam to check the reproductive organs, walls of the vagina, pelvic muscles, any discoloration of vaginal tissue, signs of infection or prolapse.
Bladder Function Tests
After discussing your specific symptoms with your doctor, nurse practitioner or physician’s assistant a decision will be made as to what tests may be needed to confirm your diagnosis.
Bladder function tests are called urodynamic studies. Urodynamic studies are done to demonstrate the urinary incontinence. There are several parts to urodynamic studies. These may include
- Ultrasound of the bladder
- Cystometrogram (CMG)
- Test for bladder filling, sensation, capacity, unwanted bladder contractions
- EMG-looking at the function of the pelvic and sphincter muscles
- Post Void Residual (PVR)
- Amount of urine left after emptying the bladder
- Uroflow
- Rate and pattern of emptying bladder
- Urethral Pressure Profile (UPP)
- Measure of resistance along the urethra
- Leak Point Pressure
- Amount of force on urethra to cause leaking
The doctor may examine the inside of your bladder using a long, thin tube (cystoscope) that slides up into the bladder through the urethra.
Clinicians who perform these studies will do everything they can to make you as comfortable as they can while giving you as much privacy as possible.
How is loss of bladder control treated?
After the tests and a discussion with your health care clinician about treatment options, a decision will be made as to what would be the best option. You need to be an active participant in that discussion and decision making.
Your health care clinician will likely offer several treatment choices. At the start of treatment may be as simple as changing some daily habits. The next may be Kegel exercises. Another treatment that may be suggested is Pelvic Muscle Rehabilitation. Other treatments require taking medicine or using a device, like a pessary to help position the bladder. If nothing else seems to work, surgery may help a woman with stress incontinence regain her bladder control.
Talk with your doctor about which treatments might work best for you.
Pelvic Muscle Rehabilitation
Pelvic muscle rehabilitation is a process that involves many techniques. Your clinician will choose the specific ones right for you. Your active participation is very important to your success. Everything will be explained to you. If you have any questions, you should ask your clinician. Don’t be afraid! If you understand why certain things are chosen, it is easier to follow through with the program. You will have homework to do in between office visits. It is important that you follow your clinician’s instructions. Sometimes we try too hard, or do more than we have been asked, thinking that will speed regaining control. Generally it takes several visits over 2 - 3 months to regain control.
Bladder/Bowel Diary
This diary is a record that generally contains some or all of the following information:
- The amount and kind of fluid consumed during a 24 hour time,.
- Leaks and activities you were engaged in at the time of the leaks.
- Number of pads or clothes changed
- Bowel movements/leaks if any
Your clinician may ask to keep this diary for a 24-hour period or other timeframe.
Pelvic Muscle Exercise (PME)
Pelvic Muscle exercises that are specifically used to assist in restoring tone to the pelvic muscles. Most people have heard of Kegel exercises. These were developed by Dr. Arnold Kegel in the late 1940’s to 1950’s. They are voluntary contractions of the pelvic muscles followed by a period of rest and then contract again. The number of repetitions will be decided by your clinician. It is important that when doing these exercises that you only tighten the pelvic muscles and not the belly, buttocks or legs and not hold your breath.
Beyond Kegels
The Beyond Kegel exercises utilize the muscles of the Pelvic Rotator Cuff to return to a balance and tone of the muscles. It uses the Obturator Internus (hip rotator attached to the Levator Ani). This muscle acts like a pulley to lift the Levator Ani. It also uses the Adductors (large muscles of the thigh attaching to pubic bone). This muscle group acts like fireworks sending electrical signal to the Levator Ani to keep it in tone while the Obturator Internus rests).
Biofeedback
Biofeedback is a process using instruments that monitor things like muscle activity and techniques like exercise and body quieting to help people learn how to control some of the things in the body that we once thought we couldn’t control. The instrument and the display are like mirrors to let you (the patient and clinician) know what is actually going on with the muscle activity or temperature. After all you can’t change something until you know what needs to be changed!
Biofeedback does not cure but teaches control.
Biofeedback-assisted PME
Biofeedback instruments are used with exercise to learn control for return to continence.
As with the exercises used, quitting the practice of exercises will lead to the symptoms returning.
The benefits of biofeedback-assisted PME are
- No side effects
- Non-invasive (minimally do to small sensors, like a tampon or suppository being used)
- Does NOT limit future options
- Involves active patient participation
- Motivating, you can see progress
Bladder Training
Bladder training is based on the bladder diary. It may be going to the bathroom at specic times, like every 2 hours. It may involve increasing the time between emptying the bladder with the end goal of reteaching the bladder to empty every 3-4 hours instead of for example every 30-60 minutes. It may take 6 weeks to accomplish.
Urge Strategies
Urge strategies are used to quiet the bladder when feeling urgency. It usually involves stopping and breathing diaphragmatically, doing several quick contractions, some mind distracting thoughts and then proceeding to the bathroom if you still feel the need to empty the bladder. Urge strategies should be practiced at home before trying them in public.
Dietary Changes
Lifestyle changes include dietary changes. There are many foods that can be bladder irritants. Some of these include caffeine, coffee, sodas (regular or diet), Aspartame, citrus juice, chocolate, spicy foods, alcoholic drinks, fluid intake and spicy foods. You should be sure to get an adequate amount of daily fiber, as chronic constipation and impaction can influence urinary continence.
Physiological Quieting (PQ)
PQ is a process of quieting the autonomic (automatic) nervous system. This system works with the bladder among other organs. It helps you learn to help quiet the bladder to decrease the feelings of urgency and to quiet the resting tone off the pelvic muscles. A CD that contains the exercise is used at night when going to bed. The use of slow, regular breathing all the way down to the belly (diaphragmatic breathing) with thoughts of hands being warm during the day assists in helping to quiet the bladder within a few weeks.
Final Thought
Whatever treatment you choose, work with you healthcare clinician as a team to achieve your personal goals. The process will generally not be as long as you have been experiencing bladder control problems.
