Female urinary incontinence is very prevalent among adult women, mostly in the form of stress  incontinence, but there are also other causes.  There are two training programs for stress incontenance that are often effective for stress incontinence, KEGEL EXERCISES and BLADDER TRAINING.  Kegel exercises tighten the pelvic floor exercises, and work 70% - 80% of the time but they need to be done routinely to maintain the benefit. Kegel exercises increase the muscle pelvic floor volume and to develop stronger reflex contractions.  BLADDER TRAINING works by scheduling voidings.  INTERNAL SUPPORT if there us a bladder prolapse, a smooth round “pessary” can be installed for support. BLADDER RE-SUSPENSION SURGERY is effective and costly.  OSTEOPATHIC MANIPULATION is usually painless and is helpful if there misalignments in the bone positions or there are abnormal muscle tightness in the pelvis or in the bladder.  MEDICATIONS are convenient, and they can have side effects and should be discussed with your Family doctor or Obstetrician/Gynecologist.



The first step in training is to understand which muscles to use and test muscle tone by inserting clean fingers in to the vagina then attempt to "draw up", as opposed to "bearing down".  A helpful “Bladder Exercise" tape is available -- Helpful tips to successful "Kegeling"


The second step is a program of routine exercise.  Maximal contractions held for 6-8 seconds followed by 3-4 rapid contractions were most effective, and recommended number of contractions is 50-100 a day.



Two different scheduling regimens are recommended for the Bladder Training to control uninhibited bladder muscle contractions. Timed voiding or habit training implies voiding on a fixed schedule. Prompted voiding the patient is asked at regular intervals about the need to void. These regimens are widely used with patients in nursing homes. For cognitively intact patients bladder training (bladder drill) has become the most popular treatment.


The main characteristics of bladder training are patient education, scheduled voidings, and positive reinforcement.   Emphasis is placed on the brain's control over lower urinary tract function.  Patients are requested to void only when scheduled, at progressively increasing intervals.  A urinary diary should be kept as an aid to treatment and as a motivating factor.  Close supervision and positive affirmation are essential for success, and the patient should be instructed in distraction and relaxation techniques.  A positive effect is often seen after a week, and unsuccessful training should not continue beyond 2-3 weeks.



Manipulation is low risk and low cost in terms of money and time.  There are many methods of treatments and all of them can help to control bladder functions.  If there is pelvic bone misalignment, an abnormal somatovisceral reflex, or abnormal tightness in the internal pelvic tissues, this type of treatment can be the only thing that works.  Usually the treatments are done externally, like a massage with your clothes on. Abnormal internal tightness is best treated intravaginally like a PAP smear.  These treatments are used France and some parts of California, but are not widely accepted in most of the United States. 



Taking a pill or inserting a cream is convenient, and they usually work if the right mechanism is targeted.  For example, if urinary incontinence accompanied by vaginal dryness suggests that intravaginal estradiol is likely to solve both problems by causing vaginal and urinary tissue to restart secretions.  There are currently two classes of medications, Estrogen Replacement Therapy (ERT) and Anti-cholinergic medications.  Both can work.  Anti-cholinergic medicines are good at drying up fluids, but the side effects can be dry mouth, dry eyes and fatigue.  Additionally, anti-cholinergic medicines may cause confusion, especially in persons over 55 years of age.  If you are pregnant, you will not be getting surgery or any of these medications and should consider trying Kegel exercises.  Discuss these medications with your Family doctor or Obstetrician/Gynecologist.


                                                Charles E Steiner, DO and specialist in Osteopathic Manipulation   rev. 08/26/2009