Stress Incontinence Treatments
- Anterior Repair and Kelly Plication
- Pubovaginal Sling Procedures
- TVT Sling Surgical Procedures (Synopsis)
- Burch Urethropexy Procedures
- Transobturator Tape (TOT) Sling Procedure
Pelvic Floor Exercises (Kegel Exercises)
This is treatment for urinary incontinence which, when done faithfully and correctly, can help decrease the urgency a patient may have and help with both urge incontinence and stress incontinence. The 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 the pelvic region, which include the bladder, large intestines and uterus. Since this muscle is often not exercised, it is generally weak to begin with, which contributes to urinary symptoms. Childbirth will weaken this muscle more because during vaginal delivery, the child's head and body push under the pelvic floor muscle and stretches it extensively, which causes temporary additional damage/weakening. Learning to do these exercises can help with incontinence; however, to perform these incontinence treatment exercises effectively, the patient must first identify the correct muscles. Two methods of identifying the correct muscles:
- While urinating stop the flow of urine by tightening the pelvic floor muscles. Do not perform the incontinence treatment exercises while urinating, since this can lead to difficulty in voiding. Stopping and starting the stream as a person voids is a popular misnomer and should not be done. Patients may elect to try to stop the stream once or twice to check for contraction of the correct muscle.
- Place a finger in the vaginal opening and attempt to squeeze the finger. Upon squeezing, the patient should feel a tightening around her finger. She has identified the correct muscles that are to be exercised.
One key point is that patients do not want to use other muscles, such as the abdomen, legs or buttocks. While doing bladder incontinence treatment, it is important to isolate the muscles only to further increase their strength. If you are moving these muscles or holding your breath, you are probably trying too hard!
When performing incontinence treatments, concentrate just on the pelvic floor muscles and do the best you can. This contraction will get easier with practice. One exercise program is described below:
- Attempt to contract and hold the muscle squeeze for 10 seconds
- Relax for a period of 10 seconds
- Perform 10-15 contractions and relaxation
- Perform this regimen 3-4 times a day
It may take awhile to 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 and that is all right. Between each contraction, relax for 10 seconds. This allows the muscle to rest adequately to be able to perform well for the next contraction. If you do not relax the muscle well enough, the muscles will tire quickly. By faithfully doing your Kegel exercises, you should see an improvement in your symptoms starting in four to six weeks.
Vaginal cones are simply small smooth cone shaped devices of increasing weight which are used to condition the pelvic floor musculature. Just like any other exercise routine this is a process of conditioning by using incremental increases of weight over longer periods of time. The user chooses a weight which she can place into the vagina and attempts to hold it in by continually tighten her pelvic floor muscles. One the patient is able to retain the vaginal weight (cone) for a specified period of time she then advances to the next higher weight and begins the conditioning process over again.
Vaginal Cones are miniature weights which are
placed into the vagina and help pelvic floor exercises.
(click to enlarge)
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