These exercises, when done faithfully and correctly, can decrease urgency and help with both urge incontinence and stress incontinence. Your pelvic floor muscle is like a hammock that stretches from the pubic bone in the front to the tailbone in the back. This set of muscles supports the organs of your pelvic region, including the bladder, large intestines and uterus. Since this muscle is not exercised often, it is generally weak, which may contribute to urinary symptoms. In addition, vaginal delivery during childbirth can further weaken this muscle. To tighten your pelvic floor muscle (PFM), imagine that you are trying to stop the passage of gas. Do not stop your stream while urinating, because doing this can lead to difficulty with voiding. You may elect to try to stop your stream once or twice to check that you are contracting the correct muscle. It is important to isolate the PFM only to further increase its strength. For the exercise program, begin by contracting and holding your PFM. Work up to a 10 second hold. In the beginning, you will probably not be able to hold for more than five or six seconds. Between each contraction, relax for twice as long as you contract so the muscle can rest adequately. If you do not relax the muscle well enough, the PFM will tire quickly. You should work up to doing 15 contractions three times a day. If you are feeling tired or the muscle is difficult to contract during the session, do not push the PFM too much. Overworking the PFM may cause some discomfort, and your symptoms could actually worsen if you push too much. For the second part of the program, contract your PFM for one or two seconds and relax for one or two seconds. Repeat this for 15 contractions. Do not worry if you need to stop a few times during the contractions to rest; it is completely normal. By faithfully doing your PFM exercises, you should see an improvement in your symptoms starting in four to six weeks. There is an even bigger improvement over time, as you continue to exercise the PFM. The easiest way to continue with PFM exercises is to incorporate them into your daily routine. In the beginning, it is easiest to contract the PFM while lying down. Try to exercise before rising in the morning and before going to bed at night. In between, fit in one or two sessions during the day. Relating the exercise to activities you perform each day can help cue you to remember to do them. For example, you may exercise while dressing in the morning, drying you hair, shaving or at a red traffic light.
Collagen is a naturally occurring protein found in humans and animals. When it is injected into the tissues surrounding the urethra, it adds bulk to this tissue and helps it close tightly and prevent urine leakage, especially urine leakage associated with activity (stress urinary incontinence). You will be awake during the injection, but you may doze off at times from medication you are given. As the procedure begins, your doctor will put some medicine into your urethra to numb the area. After this is done, a special cystoscope will be put into your urethra. When the doctor determines the areas for the collagen, a small needle in the cystoscope injects the collagen into these places. Following surgery, you will be brought to the recovery area and will feel some urgency to urinate. In fact, you may feel this urgency for the first day or two because it takes time for the body to get used to collagen being present in the urethra. Once you have urinated and are checked by your physician, you will be able to go home. Following collagen therapy, most patients will leak much less or not at all. Others will need to have one or more injections because the body will absorb some of the collagen material. The length of time between injections varies with patients. Some need to be re-injected after a few months and some after a few years. There are very few complications associated with collagen injection therapy. For example, a small amount of bleeding after the procedure is normal. In addition, there is a chance that you could have an infection following surgery. Before your physician injects collagen into your urethra, you need to have a skin test done to be sure that you are not allergic to the collagen. This involves having a small injection just under the skin of your forearm, similar to having a PPD test. This area should be checked frequently during the first few days and once a day thereafter. The physician must wait 30 days before performing the surgery to make sure that you are not allergic to the collagen. Signs of allergic reaction include redness and itching at the site of injection. New types of urethral bulking agents are also available now and work in a fashion similar to collagen. An example of this type of product is Durasphere®.
A pubovaginal sling procedure is done to create support for the bladder. This is especially effective for women diagnosed with Intrinsic Sphincteric Deficiency (ISD). With ISD, the sphincter muscle is ineffective at holding urine in the bladder during certain "stressful"" activities such as coughing, sneezing or exercising. The sling is then placed under the bladder neck and is secured in place through a vaginal incision. This procedure is done in the operating room under anesthesia, and the patient goes home the following day. At the end of the surgery, a foley catheter is placed in the bladder to drain urine and vaginal packing is also prepared. Patients are instructed on the care of the foley catheter and the leg bag that holds their urine so they are comfortable using this technique at home. A small amount of vaginal drainage is to be expected for the first week after surgery as well as again five to six weeks after surgery. Several days after surgery, the woman returns to the doctor's office and the catheter is removed. The patient is required to stay in the office area until she urinates. Following surgery, there are only a few restrictions. The patient is asked to avoid lifting anything heavier than 10 pounds for six to eight weeks. Otherwise, she is allowed to be fairly mobile. Most patients typically return to work after two weeks. Prescribed pain medication or extra strength Tylenol are usually able to alleviate any discomfort from surgery. A sling procedure is considered "curative" for the female patient, with recent statistics on patients at the 10-year postoperative mark indicating success rates greater than 90 percent.