Patient discussions
Providers can elicit the presence of incontinence in a review of symptoms during a patient encounter. After determining the type of incontinence, it is important to assess each woman’s goals and expectations for treatment to help her select the best treatment option.[7][149] If the incontinence is determined to be of bother to the woman, providers can offer pelvic floor muscle exercises (also known as Kegel exercises), behavioural modifications, and/or drugs to relieve symptoms.
Advice should be given about weight loss (if BMI over 25), reduction of caffeine intake, and how to avoid constipation. Smokers should also be given support to stop tobacco use.
She may benefit from performing regular Kegel exercises, or being referred for biofeedback, to improve urinary leakage associated with laughing, coughing, or sneezing. The key to successful results from Kegel exercises is practice. She should be instructed to perform these exercises as follows:
Locate the correct muscle group by placing two fingers inside the vagina and squeezing around the fingers.
The stomach, leg, and buttock muscles should remain relaxed while contracting pelvic floor muscles.
Contract pelvic floor muscles as much as possible to the count of 5 and then relax to the count of 5. Repeat 30 times a day (3 sets of 10).
Contract pelvic floor muscles as much as possible and then relax in quick succession. Repeat 25 to 50 times a day (5 sets of 10).
Reasonable satisfaction is attainable in most cases of incontinence; however, if the woman is not improved or does not believe the above treatment plans are congruent with her lifestyle and values, other therapies such as surgery, neuromodulation, and onabotulinumtoxinA may be options.
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