Can Urinary Incontinence Be Reversed?

Urinary incontinence is the loss of bladder control. The severity ranges from occasionally leaking urine while straining, coughing, or sneezing to having a frequent urge to urinate that occurs suddenly. Some people may only experience occasional and minor leaks of urine, while others may lose small to moderate amounts of urine frequently. Urinary incontinence can affect daily activities and quality of life; hence, it requires appropriate treatment. The treatment involves medical management and lifestyle changes.

There are six types of urinary incontinence, but the clinical presentation and causes vary with each type:

• Stress incontinence: Urine leaks involuntarily when there is an increased pressure exerted on the abdomen and bladder while straining, exercising, coughing, sneezing, laughing, or lifting heavy objects.
• Overflow incontinence: Patients have frequent and/or constant dribbling of urine because the bladder doesn't empty completely.
• Urge incontinence: There is a sudden, intense urge to urinate followed by an involuntary loss of urine. The patients urinate frequently; at times, throughout the night, which disturbs sleep. Urge incontinence may be caused by urinary tract infections or neurologic disorders.
• Functional incontinence: A physical or mental condition prevents the patient from being able to make it to the toilet in time. For example, severe debilitating arthritis or psychiatric disorders like schizophrenia.
• Total incontinence: Patients always have continuous leakage of urine. The most common cause is an abnormal communication between the bladder and the vagina, which is called a vesicovaginal fistula.
• Mixed incontinence: The patients suffer from more than one type of urinary incontinence.

Treatment options for urinary incontinence depend on the type of incontinence, the severity, and the underlying cause. A combination of medical treatments, exercises, and lifestyle modifications may be needed. Weight loss in the case of obese women has been shown to help some types of incontinence. The following are the treatment options.

Behavioral techniques:

• Fluid and diet management: Reducing or avoiding alcohol, caffeine, or acidic foods and decreasing fluid consumption.
• Bladder training: Training the bladder to delay urination after having the urge to urinate may help. The patient could start by trying to hold off going to the bathroom for 10 minutes every time there is an urge to urinate and gradually lengthening the time.
• Double voiding: First, the patient urinates after getting an urge. Then, the patient waits for a few minutes to urinate again.
• Pessary: Insertion of vaginal pessary may help reduce stress incontinence by supporting the bladder and vaginal wall. It can be inserted by the individual and may be available over the counter.

Pelvic floor muscle exercises:

The pelvic floor muscles support the bladder. Strengthening the pelvic floor muscles by exercises is recommended by the doctor, which can help manage urinary incontinence. These are also called Kegel exercises. The first step is to imagine that you're trying to stop the urinary flow and then contract or tighten the muscles to imaginarily stop urinating, and hold the position for 2-10 seconds and then relax for 2-10 seconds. This should be performed at least three times a day for a few minutes each time.

Electrical stimulation:

Electrodes can be temporarily inserted into the rectum or vagina to stimulate and strengthen pelvic floor muscles.

Medications:

• Alpha-blockers: They help treat overflow and urge incontinence. They relax the bladder muscles, making it easier to empty the bladder. Examples include tamsulosin (Flomax) and doxazosin (Cardura).
• Anticholinergics: These help to control an overactive bladder and help in treating urge incontinence. Examples include oxybutynin (Ditropan XL) and trospium (Sanctura).
• Mirabegron: This is used to treat urge incontinence by relaxing the bladder muscle and hence increasing the bladder capacity.
• Topical estrogen: Applying low-dose estrogen cream can rejuvenate tissues in the urethra and vagina.