If all else fails …
I really hope you will get help from this course but I am acutely aware that not every person will get full benefit from the exercises and this can be for a variety of reasons. So in this section we have the “where do I go from here?” options which you can explore.
Some basics for you first:
Incontinence products can be useful for managing your condition whilst you are working through the exercises or waiting for further assessment :
Absorbent pants or pads worn inside underwear. Be cautious of using sanitary pads as they don’t have the hydrophobic material to draw urine away from the surface which mean that your skin can stay damp and become sore. Absorbent pull-up pants and pads can be bought from supermarkets and chemists but for those with severe leaks then pads would need to be sourced from your healthcare team. Some pants are more environmentally friendly as they can be washed and re-used several times.
A “Just can’t wait” card allows you to discreetly let a member of staff know in a shop, restaurant, etc. that you require to use the toilet.
A “RADAR” key allows you entrance to the majority of disabled access toilets in the UK.
Incontinence bedding is available. Sheets and washable bed pads which sit over the mattress.
Portable urination devices and portable urine containment devices
Biofeedback using an electronic pelvic floor toner are available for all pelvic floors. A small probe can be inserted into the vagina (or anus if you have a penis) and this gives you an on-screen read out showing when muscles are being contracted. There are also versions which have electrodes which attach to your abdomen or around the anus which again sense the muscle contractions and give feedback on the quality and efficiency of the contraction. This can be used for both bladder and bowel issues.
Vaginal cones are small weights which are held in place by the strength of your pelvic floor muscles. This can help with training and the weight of the cones can increase as you progress.
The NHS does, as a temporary measure, suggest that tampons can be used for those with a vagina to exert pressure on the neck of the bladder and therefore help with urine leakage which takes place during exertion or exercise. This is by no means a routine solution and should be used sparingly.
The following is purely for information and a starting point for options which may be available to you through the NHS or health care provider.
It’s good to go to your GP or specialist appointment with lots of information so, for example, the bladder or bowel diary and a list of what you know your triggers to be. Think about when the leaks happen – what was their cause? How severe? Things you have done to try and help yourself. What works for you, what doesn’t. Previous illnesses and medications.
For those with a vagina an appointment will involve a discussion about your symptoms and medical history and may involve a pelvic examination. There may be a dipstick test of urine to check for infection, blood of glucose. There may also be a kidney function test and, if overflow incontinence is suspected, a residual urine test can be done via ultrasound.
For those with a penis this will involve a discussion about your symptoms and medical history and may involve an examination of the prostate. There may be a dipstick test of urine to check for infection, blood of glucose. There may also be a kidney function test and, if overflow incontinence is suspected, a residual urine test can be done via ultrasound.
For those with faecal incontinence the tests could involve an ultrasound probe which enters the anus to establish which muscles could be damaged.
An anal catheter can record muscle pressure, strengths and weaknesses. And a catheter into the urethra can do the same for those with bladder issues.
An endeoscopy (a small thin tube with a camera inserted in the anus) show defects and abnormalities in the rectum or colon. Or similar technology can be used to check the bladder and urinary tract. This procedure is called a cystoscopy.
These are medications which could be discussed with your GP –
- Duloxetine – an anti-depressant which can help increase the muscle tone of the urethra to help keep it closed.
- For urge and overactive bladder there are Oxybutynin, tolterodine and darifenacin
- Mirabegron allows the bladder to relax and therefore fill up and store urine.
- Desmopressin – helps to treat nocturia (frequent need to get up and uduring the night)
- Loop diuretic – taken late afternoon this prevents the urge to get up during the night.
Electrical stimulation – can help if you are really finding it difficult to contract the pelvic floor muscles. An inserted probe into the vagina( or the anus if you have a penis) gives the muscles a small electric current which stimulates a contraction.
Botox – injections into the wall of the bladder to relax the muscles and reduce symptoms of over-active bladder. It can also be injected into pelvic floor muscles to allow them to relax and can therefore be useful in chronic pelvic pain.
Neuromodulation therapy – stimulates the sacral nerve (in the lower back) or the posterior tibial nerve (at the ankle) using an electrical impulse. These treatments appear to make the pelvic floor muscles work more effectively.
Stoma – for extreme cases it may be advised that a stoma (or colostomy) is performed. This is an opening in the abdominal wall which removes waste product from the large intestine or bowel and stores it in a bag on the outside of the body. This can be a permanent or temporary solution.
There are surgical treatments too which would be discussed with your GP or specialist and I will not go into them in too much detail as they are beyond my training:
- A sling procedure can reduce stress incontinence by taking pressure off the bladder and strengthening pelvic floor muscles.
- For those with a vagina who are experiencing stress incontinence, a colposuspension lifts the neck of the bladder and is then stitched back into place in an elevated position.
- For urge incontinence – surgery can enlarge the bladder or implant a device that stimulates the nerve that controls the bladder.
- An implanted artificial sphincter can work as a cuff to close the urethra. A squeeze of a pump opens the cuff to release urine. This is more commonly used for people with a penis.
A bulking agent – is a material (often collagen or a water-based gel) that is injected around the urethra thus narrowing it so leakage is less likely to happen. This is used for those with a vagina whose incontinence is due to an issue with the sphincter muscle around the urethra. The same agent can also be used for those with faecal incontinence as it can build up the tissue around the anus thus making the opening narrower and allowing the sphincter to close more easily.
Sacral nerve stimulation or sacra neuromodulation – a small electrical current is sent into the sacral nerve to improve the signals between the brain and the muscles of the bladder which reduces the urge to urinate.
Catheterisation for overflow incontinence can be in 2 forms – Clean Intermittent Catheterisation which is where the catheter is passed through the urethra and into the bladder. Urine then flows through it and into the toilet. Indwelling catheterisation – whereby the catheter is left in place and a bag attached to collect the urine.