Why is incontinence incurable
Urinary Incontinence: Therapy & Treatment Options
If these therapeutic approaches are not sufficient to relieve or cure urinary incontinence, other methods such as the insertion of special tampons or vaginal pessaries and electrical stimulation are carried out.
Special incontinence tampons and ring and cup pessaries increase the pressure on the urethra. They are used and changed by the patient or the gynecologist.
With electrical stimulation, nerves that are responsible for controlling the urinary bladder and its closing mechanisms are stimulated by very small electrical impulses. This can stimulate the nerves to resume their natural task and performance.
Various operational measures can also be used:
In a so-called colposuspension, the anterior wall of the vagina under the urethra is raised by means of a laparoscopy or an abdominal incision and attached to the ligamentous apparatus of the pelvis. This prevents the urethra from sinking into too low a position.
The TVT operation (tension-free vaginal tape) is now one of the so-called gold standard. With the help of a plastic band that is placed under the urethra as a permanent insert, this area can be stabilized in a short operation.
Other procedures such as the injection of the urethra to narrow it (bulking agents) as well as self-tissue applications (fascia reinplasty) should be reserved for specialized centers.
Stress incontinence can be treated with a special substance called duloxetine. The drug must be taken permanently and the mode of action is to be assessed as limited.
The goal of conservative therapeutic approaches for urge incontinence is to lengthen the intervals between the urge to urinate and to improve the capacity of the bladder to absorb it. The following measures are usually taken:
Treatment of a urinary tract infectionIn very common cases, urge incontinence is triggered by an existing urinary tract infection. Therefore, a possibly existing infection should be treated first.
Operation of a uterus or lowering of the vagina / bladderIf, in addition to urge incontinence, there is a depression or even a prolapse of the organs of the uterus, bladder and intestine, a lowering operation should be performed first. In up to 80 percent of cases, it cures incontinence.
Urination diaryPre-menopausal women with urge incontinence often begin with a urination diary. The time of the urge to urinate and the amount dispensed are recorded over a period of a few days. For example, stress-related disorders can be distinguished from pathological signs such as those that can occur in the event of a slipped disc, the onset of cardiac insufficiency or neurological diseases.
Bladder trainingIf clear pathological causes are excluded, bladder training can be carried out. The patient tries not to give in to the first urge to urinate and thus to delay the time it takes to go to the toilet. Pelvic floor training is also useful in this context.
Estrogen therapyIn women during or after menopause, incontinence often occurs as a result of a lack of estrogen. In these cases, topical treatment of the urinary and genital area with an ointment containing estrogen or the use of estrogen tablets can improve the situation. Only medication containing estriol, applied locally or as a tablet, helps, but not hormones for the therapy of menopause.
If these methods are not successful enough, drug therapy or electrical stimulation can be used. In drug treatment, substances are used that suppress or reduce the contractions of the bladder muscles. It is important to start slowly with a low dose. The side effects are felt to be less, especially a possible dry mouth. With electrical stimulation, nerves that are responsible for controlling the urinary bladder and its closing mechanisms are stimulated by very small electrical impulses. This can stimulate them to resume their natural task and performance.
The various therapeutic approaches can also be used in combination.
There is no therapy available for reflex incontinence, which is caused by damage to or malformation of connections in the spinal cord.
The treatment of this form takes place either with estrogens (hormonal therapy), medicamentous, or surgically.
Since extraurethral incontinence is usually caused by fistulas, surgery is the most important therapeutic step. These are cut from the fabric. The bladder and vagina are then reconstructed.
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