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O U R   S E R V I C E S

There Are Many Treatment Options Available

There are a number of treatments available for women with bladder problems including behavioral therapies, pessaries or vaginal inserts, medications, and surgery. The type of treatment depends on the specific condition. The best approach is to develop an individualized treatment plan that is designed especially for you.

 

STRESS INCONTINENCE is a condition that results from an increase in pressure in the abdomen which places increased physical stress on the pelvis causing urine leakage. Coughing, sneezing, laughing, exercise, and even standing up are activities that can cause leakage in women with this type of incontinence.

Behavioral therapies, pessaries and vaginal inserts, and surgery are the three treatment options for women with this condition. The objective is to rehabilitate the pelvic floor by building the strength and function of the muscles which support the bladder, urethra and other organs contained within the pelvic region.

Behavioral treatments are simple, self-directed, have no side effects and are often used in conjunction with other treatment options. They have proven effective for many women and work well for certain types of incontinence.

Pessaries and Vaginal Insert Devices are frequently used therapies to treat bladder and pelvic support problems. These devices are placed into the vagina to provide support for the uterus, bladder, urethra, and rectum. A number of types are available and they are fit to meet the needs of each woman's problem and the requirements of her anatomy.

Electrical Stimulation. Pelvic floor electrical stimulation uses low grade electrical current to stimulate weak or inactive pelvic muscles to contract. A tampon like sensor connects to a handheld adjustable device. With the sensor in the vagina, the patient increases the current to the level of a comfortable tingle. Current is delivered in a cyclic fashion - usually 5 seconds on, 5 or 10 seconds off. Regular Electrical Stimulation sessions can be used to supplement or augment pelvic muscle exercise regimes. Units are available for home use & may be covered by medicare or insurers.

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Surgery for incontinence restores the normal anatomic position of the bladder neck and urethra. There are two main types of surgical operations for urinary incontinence: bladder neck suspension procedures and sling procedures. Within the medical community, the comparative effectiveness of these different surgeries is still being debated, and it is important that the decision be based on each woman's individual circumstances. If you are considering surgery, talk to your provider about these factors.

Medications. There are currently no medications marketed specifically for the treatment of stress urinary incontinence. However there are several experimental medications in development. You can anticipate that medications for this condition will be available in the near future.

Estrogen replacement therapy taken in pill or skin patch form has NOT been shown to be an effective treatment for female urinary incontinence. Vaginal estrogen (creams, vaginal rings, or vaginal pellets) are useful for reducing recurrent urinary tract infections in postmenopausal women. The usefulness of these preparations as a treatment for incontinence is not known.

 

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URGE INCONTINENCE/OVERACTIVE BLADDER is loss of urine that is associated with a sudden, strong desire to urinate, which cannot be postponed. This condition is also often called overactive bladder.

Behavioral therapies and medications are treatment options for people with this condition. The objective is to rehabilitate the pelvic floor by building the strength and function of the muscles which support the bladder, urethra and other organs contained within the pelvic region.

Behavioral treatments are simple, self-directed, have no side effects and are often used in conjunction with other treatment options. They have proven effective for many women and work well for certain types of incontinence.

Learn More About Behavioral Treatments:

Medications help relax the bladder and provide relief from symptoms. They can be used alone or in combination with behavioral treatments, but since they are prescription drugs they must be used under the supervision of a health care provider. Medications do not cure incontinence but can be very useful in reducing or eliminating problems of bladder control.

Estrogen replacement therapy taken in pill or skin patch form has NOT been shown to be an effective treatment for female urinary incontinence. Vaginal estrogen (creams, vaginal rings, or vaginal pellets) are useful for reducing recurrent urinary tract infections in postmenopausal women. The usefulness of these preparations as a treatment for incontinence is not known.

Electrical Stimulation. Pelvic floor electrical stimulation uses low grade electrical current to stimulate weak or inactive pelvic muscles to contract. A tampon like sensor connects to a handheld adjustable device. With the sensor in the vagina, the patient increases the current to the level of a comfortable tingle. Current is delivered in a cyclic fashion - usually 5 seconds on, 5 or 10 seconds off. Regular Electrical Stimulation sessions can be used to supplement or augment pelvic muscle exercise regimes. Units are available for home use & may be covered by medicare or insurers.

Percutaneous Tibial Nerve Stimulation (Urgent® PC). Normal voiding depends not only on normally functioning of organs and muscles, but also on well functioning nerves that deliver appropriate signals regarding urination. In overactive bladder and urge incontinence, the nerves regulating the bladder can become hyper-reactive, sending strong signals to empty before the bladder is full. Nerve stimulation therapies "jam" the pathways that transmit these abnormal messages.

PTNS uses a small acupuncture needle that is placed in the ankle along the tibial nerve. A handheld device connects to the needle to deliver mild electrical impulses to the nerve. These travel up the tibial nerve to the sacral nerve plexus which regulates the bladder. PTNS sessions are painless, last 30 minutes and are repeated weekly for 12 weeks. All sessions occur in a medical office.

Sacral Neuromodulation Therapy (Interstim®) also uses electrical impules applied directly to the sacral nerves. Then wires are threaded through openings in the pelvic bones along the sacral nerves. This is done in an operating room using local anesthesia (numbing). The wires are attached to a small external generator. If a two week test using the external device shows improvement in symptoms, a permanent device - Interstim® - is implanted under the skin. This procedure requires geneal anesthesia.

Botox Bladder Injections. Botox (Botulinum toxin A) is used to treat patients with urge incontinence that does not improve with medications or other conservative therapies. It works locally by paralyzing bladder muscle; this helps decrease unwanted bladder contractions. Maximum relief is usually seen 7 days after injection and normally lasts 6 to 12 months. repeat injections are often needed.

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PELVIC SUPPORT PROBLEMS occur when the tissues that support the pelvic organs are damaged or stretched allowing the organ to drop down out of normal position and causing a bulge. Childbirth and aging are the two most common causes of this condition.

Pessaries and vaginal inserts and surgery are the two treatment options for people with this problem.

Pessaries and Vaginal Insert Devices are frequently used therapies to treat bladder and pelvic support problems. These devices are placed into the vagina to provide support for the uterus, bladder, urethra, and rectum. A number of types are available and they are fit to meet the needs of each woman's problem and the requirements of her anatomy.

Surgery for pelvic support problems attempts to restore the normal anatomic position of the prolapsed areas and to improve symptoms, which may be caused by the prolapse. The choice of surgical procedure is individualized. Factors that may influence this choice include examination findings, previous surgery, age, other medical illnesses and patient/physician preference.

The surgery typically includes repair of tears in the fascia or suspension of the prolapsed tissues to stronger structures in the pelvis. In some cases, a graft may be used to help strengthen the area. The surgery may be performed through a vaginal or abdominal incision or a combination of both.

 

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coe@obgyn.ucsf.edu. Last updated: 09/14/2009

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