Lifestyle Changes - Treating Urinary Incontinence: Bladder Conditions

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Lifestyle changes

These are steps you can take before or in conjunction with other treatments.

Bladder training

You might be teaching your bladder some bad habits — habits that can gradually result in incontinence or frequent bathroom breaks. For example, if you routinely urinate before your bladder is full, it learns to signal the need to go when less volume is present. That can set up a vicious cycle, as you respond to the new urges and teach your bladder to cry "run" when less and less urine is present.

Luckily, old bladders can learn new tricks. Bladder training, a program of urinating on schedule, enables you to gradually increase the amount of urine you can comfortably hold. Bladder training is a mainstay of treatment for urinary frequency and urge incontinence in both women and men, alone or in conjunction with medications or other techniques. You can try it on your own or with the guidance and support of a health professional. Because bladder training is low-cost and low-risk, your clinician may encourage you to try it first, even before specific diagnostic tests are performed.

Here's a step-by-step bladder-training technique:

• Keep track. For a day or two, keep track of the times you urinate or leak urine during the day.

• Calculate. On average, how many hours do you wait between urinations during the day?

• Choose an interval. Based on your typical interval between urinations, select a starting interval for training that is 15 minutes longer. If your typical interval is 1 hour, make your starting interval 1 hour and 15 minutes.

• Hold back. When you start training, empty your bladder first thing in the morning and not again until the interval you've set. If the time arrives before you feel the urge, go anyway. If the urge hits first, remind yourself that your bladder isn't really full, and use whatever techniques you can to delay going. Try the pelvic floor exercises sometimes called Kegels (see "Pelvic floor exercises"), or simply try to wait another five minutes before walking slowly to the bathroom.

• Increase your interval. Once you are comfortable with your set interval, increase it by 15 minutes. Over several weeks or months, you may find you are able to wait much longer hours and that you experience far fewer feelings of urgency or episodes of urge incontinence.

Fluid management

Do you have a drinking problem? Not just alcohol, but water, soda, coffee, tea, or juice? For some people, eliminating excess fluid intake is all it takes to bring incontinence under control. Or you can use the following fluid-management technique along with your bladder-training program or other treatments.

Review your bladder diary (below) to see how much fluid you're drinking each day. Once your physician reviews this information, he or she may suggest changes in the amount of fluid you consume. If your urine output is much higher than 40 ounces, you may be drinking too much fluid. This isn't necessarily unhealthy, but it forces your bladder to handle more urine and may invite or aggravate incontinence. Cutting back may be helpful.

On the other hand, if your output is much lower than 30–40 ounces, it can increase your risk for urinary tract infection and, in some people, create a frequent urge to urinate because the concentrated urine irritates the bladder lining. Unless you engage in strenuous exercise or have a medical condition (such as a propensity toward forming kidney stones) that requires more fluid consumption, you can try these guidelines to improve your symptoms:

• Aim for no more than 6–8 cups of fluid (from all sources) each day (see "How much should you drink?").

• Don't drink more than 8 ounces at a time.

• Don't guzzle. The faster your bladder fills, the more likely you are to feel urgency.

• Minimize caffeinated and carbonated drinks.

• Decrease or eliminate alcohol consumption.

• If you are thirsty because it is hot or you have exercised, don't hesitate to drink water.

Pelvic floor exercises

Another approach for men and women who want to try nonsurgical methods first is to strengthen the muscles of the pelvic floor through exercise. The strength and proper action of your pelvic floor muscles are important in maintaining continence. Like weakened or damaged muscles elsewhere in your body, their condition can usually be improved with regular exercise and, if needed, physical therapy.

Basic pelvic muscle exercises are often called Kegel exercises, named for Arnold Kegel, the physician who first developed them. Regular Kegel exercises may be helpful particularly for women with mild to moderate stress incontinence. Learning to perform a strong and fast pelvic muscle contraction just before and during actions that commonly cause problems for those with stress incontinence (such as coughing or jumping) reduces leakage. Pelvic muscle exercises may help urge incontinence and mixed incontinence as well.

For men, Kegels can help prevent post-void dribbling (see "Dribble relief"). But studies have not shown Kegel exercises alone to be particularly effective in preventing or treating incontinence that results from prostate surgery.

Because Kegels cost nothing and are extremely safe, they are recommended for most patients, either alone or in combination with other treatments. To perform a Kegel, you first need to find your pelvic floor muscles and then repeatedly contract and relax them.

• Locate your pelvic muscles. Pretend you are trying to avoid passing gas; in addition, if you are a woman, you can pretend to tighten your vagina around a tampon. Both actions involve the pelvic muscles. You will feel a correct contraction more in the back than the front, like you are pulling the anal area in.

• Choose your position. You can start by lying on your back until you get the feel of contracting the pelvic floor muscles. Later, you can practice while sitting and standing as well.

• Practice contractions. Practice both short contractions and releases (sometimes called "quick flicks") and longer ones (gradually increasing the strength of the contraction and holding it at your maximum for up to 10 seconds). Consciously relax the muscles between each repetition, and hold the relaxation phase for the same amount of time as the contraction.

• Keep other muscles relaxed. When doing pelvic floor exercises, don't contract your abdominal, leg, or buttock muscles or lift your pelvis. Place a hand gently on your belly to detect unwanted abdominal action.

• Repetitions. Your health professional may advise you how many Kegel exercises to do. It is more effective to spread the exercises throughout the day than to do them all at once. One simple starting regimen is to do 10 before getting out of bed, 10 standing after lunch, 10 in the evening while sitting watching TV, and another 10 before going to sleep. You can do them at other times as well: in the car sitting at a stoplight, waiting for an elevator, or waiting in a grocery line.

• Determine your strategy. You can practice using these exercises to control your symptoms. If you have stress incontinence, tighten your pelvic floor muscles just before lifting, coughing, laughing, or whatever usually causes urine leakage. Do the same several times when you have the urge to urinate and doubt you are going to make it to the toilet. This should relax your bladder muscle so you can walk to the toilet under control.

• Be consistent. Practice consistently, using whatever schedule works for you. It may take a few months for you to notice an improvement in your symptoms.

Biofeedback

Both men and women can make use of biofeedback, a technique that detects information about a biological function (for example, heart rate, skin temperature, or muscle tension) and provides feedback so you can gain greater awareness and control over that function. In the case of incontinence, biofeedback can help you identify pelvic floor muscles and learn to strengthen and control them in order to lessen stress incontinence, urge incontinence, and mixed incontinence.

For a biofeedback session, the practitioner inserts a small monitor into your vagina or rectum, or both. Electrodes may also be pasted on your belly to monitor abdominal contractions. As you perform your assigned pelvic exercises, you watch a computer screen and see a line or image (such as clouds or birds) rising as you contract the correct muscles more strongly. Some people have a single training session using biofeedback, while others go for six or more sessions spread over several weeks.

Experts disagree about whether biofeedback is an effective technique. According to a 2006 Cochrane review of medical studies, pelvic floor muscle training plus biofeedback reduced urinary leakage after prostate removal by 26%, while research on the benefits of other noninvasive treatments (such as pelvic floor muscle exercises without biofeedback) were inconclusive.

Home exercise aids

Another choice for women who want to try noninvasive methods are devices that help you do pelvic muscle exercises consistently and effectively at home. Research shows that vaginal weighted cones, biofeedback, and pelvic floor exercise alone all yield comparable results. Exercise contraptions that you squeeze between your legs generally do not work because they don't exercise the right muscles.

Vaginal weighted cones. Some women find that using vaginal weighted cones helps boost the power of their pelvic floor exercises. These are a set of smooth, tampon-shaped inserts of increasing weight. If you have significant uterine prolapse or a rectocele, your doctor will probably not recommend this method for strengthening your pelvic muscles.

To use vaginal cones, start with the lightest (less than 1 ounce) and insert the cone into your vagina as you would a tampon. A lubricant may make insertion more comfortable, but it also makes the cones slippery. Then, contract your pelvic muscles to hold it in place. If contracting your muscles pushes the cone out, it may not be inserted far enough, or you may be pushing out with your abdominal muscles.

Vaginal cones function both as a strengthening tool and as a simple biofeedback device. If the cone stays in, you're contracting your muscles correctly. Start with 3–5 minutes, twice a day. Work up to 15 minutes, twice a day. Once you can hold a cone in place while walking, coughing, or going up and down stairs, switch to the next heavier cone.

Home biofeedback devices. These handheld electronic devices let you know how strongly you are contracting your pelvic muscles when you practice Kegels. Muscle strength is detected with a vaginal sensor and displayed on the handheld component. FDA-approved systems (such as Myself or the PFX Pelvic Floor Exerciser) are available without prescription. In other systems, you buy the vaginal probe and rent the biofeedback device by the month. The PFX device is available in a men's model that uses an anal probe.

Conditioning without exercise

Some men and women find that they are unable to exercise their pelvic muscles consistently or effectively, or would appreciate help in beginning to condition the muscles. Two types of devices are available that contract the pelvic floor muscles without any effort on your part.

Electrical stimulation. Men and women can use either a portable device at home (such as Liberty, by Utah Medical) or a larger system in a health professional's office. A small electrode placed inside a woman's vagina or a man's or woman's rectum delivers an electrical current that can spur your pelvic muscles to contract painlessly. You will feel as if you are doing a Kegel. The instruments can be set for different strengths of stimulation and various time intervals of contraction and relaxation. For stress incontinence, electrical stimulation is believed to work by strengthening the muscle. For urge incontinence, a different frequency may help reset your nervous system's control over the bladder muscle. Medicare will cover pelvic muscle stimulation if it is prescribed by your physician and you can document that you have tried standard pelvic muscle exercises for four weeks and not gotten relief.

Pulsed magnetic fields. Another method of rehabilitating a weakened pelvic floor suitable for either men or women employs pulsed, focused magnetic fields generated by a patented device called NeoControl, available in some medical clinics. Pulsed magnetic energy causes the muscles to contract by stimulating the nerves that control them. This approach is the same as that used to keep muscles from atrophying while an athlete is in a cast. For the treatment, you sit fully clothed on a special chair. During a 20- to 30-minute session, the chair sends pulsed magnetic fields to your pelvic floor. Your doctor will determine the optimal strength and frequency of the pulses. Treatments are painless, but you will feel your muscles contracting without any effort on your part. A typical treatment series involves 16 sessions spread over 8 weeks. A urologist or urogynecologist is most likely to have this device in his or her office.

Last updated:	September 05, 2008