Non-surgical treatments often are sufficient in improving function and decreasing symptoms of pelvic floor conditions. Following are some of those treatment options.
Pelvic Floor Rehabilitation
Pelvic muscle rehabilitation is often an essential part of treatment for pelvic floor disorders. Rehabilitation includes pelvic exercises designed to train the pelvic floor muscles (known as Kegel exercises), increasing the patient’s the ability to hold and release urine and stool.
Many of these exercises can be done anywhere, at any time and in various positions, so they are easily integrated into everyday routines. In addition, pelvic pain disorders may be treated using pelvic floor muscle relaxation techniques and manual therapy.
Targeting the right muscles is key with Kegels. Your doctor or physical therapist can help you determine how to most effectively contract your pelvic floor muscles.
Many people find it difficult to contract and relax the pelvic floor muscles, so it's important for a healthcare provider to make sure that patients are doing the exercises correctly. The specialized physical therapists at the Integrated Pelvic Health Program are an excellent resource for this unique therapy. They use techniques such as biofeedback, electrical stimulation and manual therapy to optimize treatment and improve bladder and bowel function.
There are a variety of medications that treat incontinence. These medications are especially useful for treating an overactive bladder (OAB) associated with urge incontinence; however, many patients with mixed symptoms of overactive bladder (OAB) and stress incontinence will benefit from medical therapy.
Some medications that may help with urinary incontinence include:
- Topical estrogen: low-dose topical application of estrogen may help rejuvenate and tone tissues in the urethra, reducing some of the symptoms of urinary incontinence
- Imipramine (Tofranil®): this antidepressant can be used to treat urgency and/or painful bladder syndrome
- Anticholinergic drugs: many of these types of drugs can help treat OAB, such as: oxybutynin (Ditropan®), solifenacin (Vesicare®), fesoterodine (Toviaz®), tolterodine (Detrol®), darifenacin (Enablex®) and trospium (Sanctura®)
Some medicines that may be used to treat fecal incontinence include:
- Anti-diarrheals: Imodium® may be used to help treat diarrhea
- Laxatives: these may be used if chronic constipation is responsible for fecal incontinence
- Stool softeners: these can reverse the effects of constipation and impacted stool
Pain disorders, such as painful bladder syndrome or pelvic pain, may be treated with neuromodulators, muscle/joint injections and other medications in conjunction with other treatments.
Constipation can aggravate rectal prolapse and other defecation difficulties. Patients suffering from these disorders should avoid constipation. In some cases, dietary changes will be enough, but it's possible that medication may be necessary.
All medications have the potential for side effects. Your healthcare provider will carefully weigh the risks versus the benefits of medications and will discuss all of the options with you before prescribing medication.
There are a number of interventional therapies that can be used to help treat urinary incontinence, designed specifically for women. Following is a description of some available therapies.
A pessary is a firm silicone ring inserted into the vagina designed to help support the bladder and/or urethra and prevent leakage. The device must be regularly removed for cleaning.
Pessary use is very individualized. Some patients only use the device when an activity requires additional support (e.g.,during exercise). Other patients may find it helpful to use the pessary all day and night. Pessaries also can help women with a prolapse, which is a condition characterized by the pelvic organs dropping down into the vagina. Pregnant women who experience incontinence may find relief of that symptom when using a pessary.
Your doctor may inject very small, non-absorbable materials into the tissue surrounding the urethra. This helps keep the urethra closed and reduces leakage of urine. Requiring minimal time and minimal anesthesia, this procedure can typically be done in your doctor’s office. Repeated injections may be required.
Injections of Botulinum toxin (Botox®) into the bladder muscle may benefit individuals who have OAB. This therapy has shown promise for treatment of incontinence, but FDA approval is pending. Repeat injections may be needed every six to nine months.
Anal bulking agents
Solesta® is a gel administered through four injections into the wall of the anal canal. It bulks up the tissue in the anal canal, giving the individual greater control. Since the injections are tolerated well by most patients, anesthesia is not necessary.
For more information or to make a confidential appointment with one of our physicians, please call the Integrated Pelvic Health Program at 312-926-4747.