There are many people who suffer from some level of incontinence and there are quite several options available. One of the most readily available options is pads, briefs and diapers which can be purchased in the stores or discretely online, but this option is not for everyone and it does not address the underlying cause of the incontinence. Medications tend to be the next level of medical options with several types of drugs that work in different ways on the bladder. Mirabegran (Myrbetrix) is a drug that relaxes the bladder muscle to keep it from quivering and spasming, creating the urge to pee. According Mayo Clinic, 1 in 3 men and women over the age of 40 have or have had OAB, Over Active Bladder, causing some leaking. Anticholinergics work similarly to reduce unwanted bladder contractions.

Other options for men and women are Cymbalta (duloxetine) and Tofranil (Imipramine) are tricyclic antidepressants (TCA) which are mainly used as antidepressants but also help to relax the bladder while also helping the sphincter to contract. The interesting thing here is the incontinence can lead to a bit of depression, so this option becomes a 2 for 1 deal! Take care of both at the same time.

The next option is a drug familiar to us via plastic surgery, Botox. Botox is used in severe cases of bladder spasms and urgency where the person gets the urge to void and then almost immediately find themselves voiding. While this treatment works well it also comes at some risk. It uses botulinum bacteria to temporarily shut off the nerve. Therefore, it is so popular for eliminating wrinkles in the face, but it is a paralyzing agent and you need to keep coming back for more injections.

Women are lucky in that they can get a pessary. It is a ring that is inserted into the vagina to provide support to the pelvic organs (bladder, bowel, and vagina) that have prolapsed. This is a great non-surgical alternative that can greatly improve a woman’s quality of life but sometimes that is not quite enough to keep us from leaking. From here we explore surgical options.

Anatomy relies on its shape in order to function correctly. If your pelvic organs have dropped a little then they are not going to be in the correct position to do their job, causing either pain or incontinence (bladder and/or bowel) or both incontinence and pain. A suspension is a surgical option for many people and involves the urologist implanting a mesh that repositions the intended organs into their correct position, whether it be the bladder or the vagina or both.

Men get another option, an artificial valve. This is as simple procedure involving a cuff to go around the urethra that is connected to a reservoir in the abdomen and a pump in the scrotum. The cuff remains inflated thus closing the urethra. When the person needs to void the use the pump in the scrotum to deflate the cuff thus allowing the flow of urine. The cuff automatically inflates from the reservoir and closes off the urethra again.

There is one final option regarding incontinence and that is pelvic physical therapy. I treat incontinence and often find it is easiest to treat if I see the person sooner than later when symptoms arise. I often find the pelvic floor muscles are weak, sometimes tight and need to be released. I also work with people to teach them how to do a proper Kegel, as most are surprised at how challenging it really is. I achieve this with electromyography and biofeedback with results coming quickly.

If you are having any symptoms of incontinence and want to get off the pad, have a frank conversation with your doctor. If you find the conversation difficult, then reach out to me for a free consultation. Given the current health crisis of COVID 19 we can video chat to go over your specific needs. Be well! Wash your hands and practice social distancing of 6 feet.

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