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Step-by-step treatments

Step-by-step approach to treating incontinence

A step-by-step approach is used for incontinence treatment, offering the most non-invasive incontinence therapies initially and working incrementally through the steps until an effective solution is found.

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Bladder incontinence in women is very common. 40 per cent of women experience incontinence, but only five per cent will need surgery. Frequently, patients respond well to more conservative incontinence treatment. However,  all forms of advanced surgical techniques are available for those with persistent problems.

 

 

Male bladder health

 

 

Bladder symptoms also occur in men, and 5-10% of men suffer from some degrre of urinary leakage. Incontinence can also occur after prostate surgery.

Non-invasive treatments

Invasive treatments

There is now a wide range of established treatments for incontinence, with many effective, non-invasive options. You should not feel that you simply have to put up with problems which often have a very distressing and limiting impact on lives.

Jeremy Ockrim, Consultant Urologist

Step 1: Behavioural Therapy for Incontinence

Behavioural changes, such as changing the volume, timing and what you drink throughout the day is often a very effective incontinence treatment without the need for any surgical treatment at this stage. Our specialist nurses (Julie Jenks) can guide you through fluid assessment and management.

Step 2: Pelvic Floor Exercises to Treat Incontinence

This involves exercises to strengthen the pelvic floor – these muscles are tightened to help involuntary leakage, and can be trained to stop yourself from passing water. Like behavioural therapy, this incontinence treatment does not require any surgical treatment. Our specialist nurses (Julie Jenks) teaches specific techniques (the knack) and encourages patients with exercise programs.

Pelvic Floor Rehabilitation with Biofeedback

This is an effective incontinence treatment which is popular with patients. It involves using a small probe to measure muscle movement and the results are projected onto a computer screen. Patients can see how their muscles work and exactly how much harder they need to work in order to gain full control. Muscles are re-trained, initially using the computer guidance and then without guidance.

Bladder Retraining to Treat Incontinence

 

Bladder retraining is a method of  incontinence treatment which gradually increases the time between your visits to the toilet, so that your bladder is able to hold larger quantities of urine comfortably.

Step 3: Incontinence Treatment Medication

Medication can be an effective incontinence treatment. Different types of drugs are used for specific types of incontinence, with anticholinegic medications used for urgency and a different group of medication for mild to modest stress incontinence.  Expert advise is given for the best treatment for individual needs.

Step 4: Acupuncture and Percutaneous Nerve Stimulation (PTENS) Incontinence Treatment

Studies show acupuncture can be effective in terms of increasing bladder capacity and reducing discomfort. Percutaneous nerve stimulation is an advanced form of acupuncture where the needle stimulation is augmented with electrical current. It has been shown to be an effective incontinence treatment for patients with frequency and urgency which result in leakage before the patient can access toilet facilities. The electrical stimulation inhibits the nerve impulses that cause unwanted bladder contraction, resulting in urgency.

Step 5: Minimally Invasive Incontinence Treatment Techniques

 

Sacral nerve stimulation

 

This is a more advanced technique in which the nerves controlling the bladder are stimulated directly through the lower end of the spine (through the sacrum). The technique is effective for overactive bladder, as well as patients who have difficulty voiding. It has also been used for patients with pain syndromes to reduce the sensations of discomfort. This technique is performed in two stages, and if the test is effective a bladder pacemaker similar to a heart pacemaker is implanted, and lasts for 5 years.

Mr Ockrim is a national specialist in sacral nerve stimulation, and alongside nurse specialist Julie Jenks has the largest experience of sacral nerve stimulation for bladder dysfunction in the UK.

We have been amazed at our patients’ responses to the new sacral nerve stimulation technique. The implant has revolutionised their lives and allowed them to return to social activities, where they had previously lost confidence. We offer continued after care to adjust the device settings according to our patients’ individual needs.

Julie Jenks, Specialist Nurse Practitioner, University College Hospital, London

Step 6: Incontinence Treatment Surgery

Surgery is normally only considered for significant stress incontinence. Most people with an overactive bladder are likely to have found a solution in the first five steps of incontinence treatment. People who continue to experience problems with stress incontinence following the first five steps of treatment may have structural problems which need to be addressed by surgery.

Bladder surgery has rapidly developed during the past ten years and while surgical options for incontinence treatment need to be very carefully considered, success rates are over 80 per cent.

The main types of surgery for stress incontinence are:

For men who have incontinence after prostate surgery the options include

For those patients with the most severe urge incontinence surgery involves clam cystoplasty where a small segment of your bowel is used to augment your bladder and prevent bladder spasm. This is a more extreme incontinence treatment used only in a small number of cases.

Each patient is given incontinence treatments which are appropriate for their condition, with an emphasis upon minimally invasive approaches, although the full spectrum of more complex solutions are available for those with severe difficulties.