Treatment of Incontinence

If you experience incontinence here are some things you need to know:

• You are not alone – incontinence is common in men and women across all ages
• You do not have to just “live with it”
• Some medical conditions that cause incontinence can be treated
• Incontinence does not have to be a part of aging
• There are various management and treatment therapies to help improve continence
• You should tell your doctor

Incontinence is a chronic, stressful, and limiting disorder. Treatment for incontinence should begin with attention to how you manage and what effect incontinence has on your daily life. Attention then can turn toward ways to minimize or contain incontinence.

"Managing incontinence means confronting and dealing with issues involving uncertainty, loss, and control."

Management and treatment may include a combination of the following:

• Lifestyle changes – being prepared
• Dietary changes
• Medication
• Bowel management/retraining program
• Biofeedback therapy (neuromuscular reeducation)
• Surgery to repair muscle damage
• Surgery to create a diversion/colostomy
• Other newer procedures or devices

An effective management plan for incontinence not only minimizes episodes but also allows you to regain a sense of personal control. Management plans are tailored to address each individual’s specific symptoms and may include a number of approaches.

Lifestyle changes – being prepared

Managing incontinence often means being prepared. Knowing what to do when it does happen can help prevent fear from consuming your life. For example, it helps to always have cleanup supplies and extra clothes on hand, and although difficult to accept, protective undergarments may be a good idea. Locate the restrooms in public places and make sure that you can get to them easily. Flexibility is important, too, since plans may need to be changed at the last minute.

Dietary changes

Diarrhea and constipation contribute to incontinence for many individuals. In some cases, food choices can be modified to improve bowel function and continence. For example, it may help to reduce or avoid dietary choices that stimulate the gut and may provoke diarrhea such as meals that are too large or high in fat, fried foods, coffee, caffeine, alcohol, and foods containing the sweeteners sorbitol and fructose. Here are some tips on diet. 

Medication

Medications can help improve diarrhea and constipation or assist in the development of a more predictable bowel pattern. Examples include antidiarrheal medications, fiber supplements, stool softeners, and laxatives. 

Bowel management/retraining program

Bowel management or retraining involves designing a program to help develop a more predictable schedule for elimination and decrease unpredictable episodes of incontinence. This may include dietary changes or the use of medication as well as establishing a habit regimen. It also involves the ability to respond and availability of toilet facilities when feeling the need to have a bowel movement (the ‘call to stool’).

Biofeedback therapy

Biofeedback therapy for incontinence involves re-educating muscles and nerves using special sensors to help a person change bodily functions they are usually not aware of. Working with a trained therapist can help to modify or change abnormal responses to more normal and effective patterns. It is essential to find and work with a therapist knowledgeable in disorders associated with the pelvic floor and rectum. The goal of biofeedback therapy is to:

• Improve ability to detect contents in the rectum
• Improve ability to contract pelvic floor muscles in response to sensation

Repair surgery

Surgery to repair the anal sphincter may be an option for some people who have not responded to less invasive treatments and have muscle damage but functioning nerves. However, improvements appear to deteriorate over time. Different techniques can be considered depending on the type or extent of damage.

• Sphincteroplasty is a technique to attempt repair of anal sphincter muscles
• Muscle transposition is a technique of transferring a muscle from another part of the body and wrapping it around the anal canal to act like a sphincter. 

Newer treatment options

Other newer treatments continue to be developed to improve continence. These range from nerve stimulation in the lower pelvic area, to implants, and injection of bulking materials. There is hope through research that additional therapeutic options will continue to be made available for patients with incontinence unresponsive to current treatments.

Two newer treatment options are:

• InterStim Therapy is an implantable system designed to improve bowel control that uses mild electrical stimulation of the sacral nerves to influence the behavior of the pelvic floor muscles and bowel. In the U.S. it was approved in 2011 by the FDA for the treatment of chronic bowel incontinence in patients who have failed or are not candidates for more conservative treatments.
• Solesta is a sterile gel that is injected into a part of the anal canal to improve bowel control in patients for whom conservative therapies have failed. Solesta has been available in Europe since 2006. It was approved in 2011 by the FDA in the U.S. and will be available to patients beginning in September 2011 through the offices of colorectal surgeons.

Diversion surgery

Some individuals with severe incontinence who have had no success with management plans or treatments choose to have a colostomy. Stool leaves the colon through a surgically created opening in the abdomen where it is collected in a pouch. A colostomy does not restore continence, but it can give individuals control over defecation and may allow them to resume normal activities.

Summary

Although current management and treatment options do improve the quality of life for individuals with incontinence and can mean the difference between social isolation and a productive life, these measures do not guarantee a return to complete continence.

Even after initial success with biofeedback or surgery, many people do not retain the post-treatment degree of continence long-term. There is a great need for research aimed at finding innovative treatments to improve lives of affected individuals.