When conservative measures fail to improve urinary leakage in women with urge incontinence, pelvic stimulation should be the next step. “The vast majority of women find pelvic stimulation effective. It can be life-changing,” says Holly L. Thacker, MD, Professor and Director of Cleveland Clinic’s Center for Specialized Women’s Health.
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The American College of Physicians recommends physical therapy (PT) as a first-line treatment for urge incontinence, often referred to as “overactive bladder.” Pelvic stimulation devices are embedded with electrical sensors that strengthen pelvic floor muscles, giving the patient more control over her bladder function.
“In essence, pelvic stimulators enable a woman to perform PT in the privacy of her own home,” says Dr. Thacker.
When to suggest pelvic stimulation
After a urine culture has ruled out infection, cancer or other potential cause for incontinence, the first line of treatment is to avoid foods that irritate the bladder. Losing weight, if appropriate, can be helpful. “A difference of only 5 to 10 pounds can relieve pressure on the belly,” Dr. Thacker explains.
Bladder retraining with Kegel exercises is also advised. However, 20 to 30 percent of women are unable to perform these exercises effectively. If lifestyle changes and bladder retraining do not improve incontinence, medication is the next step. However, incontinence medications can cause side effects, interact with many common medications, are expensive, may not be well tolerated and have contraindications.
For these reasons, pelvic stimulation can be a useful alternative. “It has no side effects and is easy to use. I’ve used it to treat women in their 90s,” says Dr. Thacker. Contraindications to use include vaginal prolapse and the inability to follow directions. Stimulation may be ineffective in patients with nerve damage from stroke, multiple sclerosis or other disease.
About pelvic stimulators
Different pelvic stimulators accommodate a variety of needs and vaginal sizes. One model relaxes the detrusor bladder muscle; another is designed to treat mixed leakage; a third model treats fecal as well as urinary incontinence; a fourth model stimulates the pelvic floor and the bladder. All require custom fitting by a women’s health specialist.
Pelvic stimulation must be performed daily for five minutes to be effective. Once continence is achieved, one session a week is usually sufficient.
Although complete continence may require three to six months to achieve, positive changes may occur almost immediately. “I’ve seen many patients improve in as little as a week or two,” says Dr. Thacker.
When the long-term costs of options for treating incontinence are considered, pelvic stimulators are cost-effective. The latest model to receive FDA approval costs about $340, whereas adult diapers cost approximately $750 a year. All models come with a money-back guarantee. Medicare will pay for some approved models.
Advice to physicians
Because many women with incontinence fail to raise the issue with their physician, Dr. Thacker suggests physicians take the matter into their own hands. “It’s up to the physician to ask about incontinence at least once a year and to communicate that bladder leakage is not a normal part of aging,” says Dr. Thacker.