Treatment options for incontinence
Toilet training
Keeping a bladder diary (“micturition diary”) gives us an insight into when and how much you drink and how often you go to the toilet (“micturitions”). With this information we can draw up a drinking and urination plan. It tells you how much you should drink per day and when you should go to the toilet – even if you don’t have the urge to urinate. Emptying your bladder regularly should prevent you from leaking urine uncontrollably.
Pelvic floor training
Pelvic floor physiotherapy can improve symptoms of various forms of incontinence. It is the treatment of choice for stress incontinence and helps with irritable bladder symptoms. Organ prolapse and pelvic pain, including pain in the genital area, bladder pain, anal pain or lower abdominal pain, can also be relieved by physiotherapy. After a thorough assessment, the physiotherapist specializing in pelvic floor rehabilitation will examine your pelvic floor muscles and instruct you on how to train, relax and use them in everyday life, depending on the findings. Tips on everyday behavior and equipment-based measures, such as biofeedback or electrostimulation, supplement the therapy.
Hormone preparations
If an oestrogen deficiency (e.g. during the menopause) is the cause of incontinence, hormone preparations can replace the missing messenger substance. They are administered as vaginal ointment or suppositories.
Losing weight with incontinence
Being overweight can further weaken the pelvic floor and worsen existing incontinence. To reduce the strain on the pelvic floor, you should try to lose excess kilos. Weight loss can be individually supported with the help of the University Hospital’s nutritional counseling service.
Medication
Depending on the cause, various medications are also available to treat incontinence. In the case of infections, we usually prescribe anti-infective medication to combat the pathogens. There are now a number of alternatives to antibiotics, which we will be happy to advise you on during our consultation. Antispasmodics (e.g. oxybutynin, trospium chloride, darifenacin, solifenacin) are mainly used for urge incontinence. The active ingredient duloxetine, a selective serotonin-noradrenaline reuptake inhibitor, can alleviate the symptoms of stress incontinence.
Bladder instillations
Various bladder diseases, such as chronic inflammation, can lead to an irritable bladder. Irritable bladder or other painful bladder conditions severely restrict the quality of life of those affected. This can be remedied by inserting special solutions containing hyaluronic acid or chondroitin sulphate into the bladder (“instillation”) to treat the symptoms directly in the bladder. Based on years of experience, we have put together various instillation solutions in collaboration with the Zurich Cantonal Pharmacy, which are instilled into the bladder by our specialized urocare specialists.
Depending on the bladder disease, ionic-balanced solutions can be introduced into even deeper layers of the bladder wall by means of electromotive drug application (EMDA) to optimize therapy.
Surgical therapy
Before surgical treatment, the type and severity of urinary incontinence must be assessed. This is done in the functional examination of the urinary bladder, the so-called urodynamic examination.
At the University Hospital Zurich, experts with many years of experience and a specialization in urogynecology will advise you on bladder and prolapse operations. A second opinion consultation is also available.
Certain forms of urinary incontinence can only be corrected surgically, for example extraurethral incontinence. The urine is discharged via incorrect routes, so-called fistulas. Our experts in urogynecology perform the operations via a minimally invasive approach or with robotic assistance. If the fistula is located far down in the pelvis, such as a vesicovaginal fistula, we can often approach it purely vaginally and therefore with minimal invasiveness and without an additional abdominal incision, which can speed up your healing process.
To restore urethral function, for example, we can use a tape around the urethra: the “Tension-free Vaginal Tape” (TVT) incontinence sling. Urogynecologists are leading the way in surgical techniques for the treatment of urinary incontinence in women and are involved internationally in scientific outcome measurements and have extensive experience in the individual fitting of slings.
Occasionally, the narrowing and support of the urethra with so-called “bulking agents” is suitable for the treatment of urinary incontinence. These plastic fillers can be injected around the urethra during a short inpatient stay and under local anesthesia.
Alternatively, and depending on the pre-existing condition, urinary incontinence can be treated using laparoscopy (“Burch laparoscopic colposuspension”). Urine loss is corrected by raising the lowered organs and increasing the urethral closure pressure.
If physiotherapy and drug therapy do not help with your overactive bladder, injecting botulinum neurotoxin into the bladder can lead to long-lasting improvement. This treatment can be repeated if the effect wears off. A so-called bladder pacemaker can also be used to either calm an overactive bladder or to activate a bladder that can no longer empty itself. Depending on the individual case, we will decide together with you whether and when which procedure is suitable for you.
The examinations and treatments take place in our special urogynaecology consultation at the Women’s Clinic. As an interprofessional team of specialized urotherapists and doctors, we work hand in hand to improve your pelvic floor health.
