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Treatment

Options of course vary with the specific problem you are having. In some cases, lifestyle changes alone are adequate, such as diet, exercise, weight control, and smoking cessation. Treatment options are non-surgical (e.g., pelvic floor muscle exercises, pessaries, medications, physical therapy) or surgical.

Non-Surgical Options

  • Holy Cross Hospital offers outpatient Continence and Pelvic Floor Therapy Services.
  • Medications may be effective in decreasing the activity of the bladder muscle to reduce urgency and/or urge incontinence. Various medications for anal incontinence are available and are directed at slowing passage of stool through the colon, increasing muscle tone of the anal sphincter, bulking agents, and reducing stool frequency. 
  • Bowel and bladder training therapies include toileting schedules and biofeedback exercises to help restore pelvic muscle strength.
    • Kegels are pelvic muscle strengthening exercises. These may be helpful in managing urinary and fecal incontinence in both men and women, for treating vaginal prolapse and preventing pelvic organ prolapse. The exercise consists of contracting and relaxing the pelvic floor muscles. While not always necessary, a Kegel exerciser is a medical device used by women to assist in exercising the muscle. For prevention purposes, experts often recommend doing sets of 10 Kegels (holding each contraction for 10 seconds), three times a day.
    • Behavioral therapy focuses on symptom control through dietary management, fluid control and toileting schedules.
  • Pessaries are appliances that are inserted into the vagina to help support pelvic organ prolapse and help improve bladder emptying and hopefully reduce overactive bladder and stress or urge incontinence.
  • Double voiding is often effective for incontinence related to incomplete bladder emptying or urinary retention. After you finish urination, wait several minutes keeping your pelvic muscles relaxed, and then attempt to void (empty your bladder) again. Sometimes it helps to press down above your pubic bone to place pressure on your bladder while urinating, to help with emptying.
  • Sometimes self catheterization

Surgical Treatments

Urinary Incontinence:

  • Research has identified two basic kinds of major surgical procedures that seem most effective for treating stress incontinence in women - the retropubic urethropexy and the midurethral sling. Many minimally invasive slings made of polypropylene mesh are available. The mesh tape is placed underneath the midurethra through a small vaginal incision. They have shown high success rates with minimal risk and is usually the surgical procedure of choice. A more minor collagen injection into the urethra is also available for a few subset of patients.
  • Interstim or a bladder nerve stimulating device can be used for patients with the worst cases of overactive bladder and/or urge incontinence.

Abnormal Bladder Emptying:
Options include treating a stricture of the urethra (rarely present), any treatable neurological abnormalities, Interstim and treating obstruction of the urethra with from pelvic organ prolpase with pelvic reconstructive surgery.

Pelvic Organ Prolapse:
Abdominal and vaginal surgeries to support the bladder, vagina, and rectum are available with high success rates. If uterine prolapse is present, hysterectomy is usually performed if child bearing has been completed. Surgeries must be tailored individually based on the components of a patient's prolapse.

Anal Incontinence:
These procedures are generally performed by colorectal surgeons.

  • Sphincteroplasty, sphincter replacement, and sphincter repair are common options.
  • Injection of biomaterials into the anal sphincter to increase the size of the sphincter.

 

 

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Holy Cross Hospital | 1500 Forest Glen Road, Silver Spring, MD 20910 | 301-754-7000