Urinary Incontinence In Women: Treatment Overview

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Treatment Overview

There are several possible treatments for urinary incontinence. The best treatment depends on the cause of your incontinence and your personal preferences.

Key points

• Most of the time, incontinence can be cured or at least managed.
• For stress incontinence, many women get good results from using Kegel exercises, timed urination training, lifestyle changes, and medical devices such as pessaries. You have the best chance of success when you stick with them. For difficult-to-treat stress incontinence, surgery can help. New surgical techniques are minimally invasive and can have quick recovery times.
• For urge incontinence, learning to retrain the bladder is often helpful. Medicines may also help, although they tend to have bothersome side effects. Surgery is not considered an effective treatment for urge incontinence.¹

View and print a voiding log (What is a PDF document?) for keeping track of your symptoms.

Exercises and lifestyle changes

Pelvic floor (Kegel) exercises help 50% to 75% of women to decrease the occurrence of stress incontinence.³ These exercises, which strengthen the pelvic muscles involved in urination, are especially useful for stress incontinence, but may also help urge incontinence. Making sure you do these exercises correctly and doing them regularly are key in succeeding with this method.

Kegel exercises may be combined with biofeedback techniques to help you know whether you are tightening the right muscles. This can also be done by placing a finger in your vagina so that you can feel the pelvic muscles contract. Also, to prevent leakage when you feel a sneeze or cough coming, try a Kegel by tightening your pelvic floor muscles. Crossing your legs may also help.

Losing weight often helps stress incontinence.

Sometimes making lifestyle changes can help with urge incontinence. Try to identify any foods that might irritate your bladder—including citrus fruits, chocolate, tomatoes, vinegars, dairy products, aspartame, and spicy foods—and cut back on them. Also, avoiding alcohol and caffeine usually helps.

Behavioral methods

Three types of behavioral methods are used to treat urinary incontinence: bladder training, timed urination, and prompted voiding.

Bladder training (also called bladder retraining) is used to treat urge incontinence. With bladder training, you increase how long you can wait before having to urinate by trying to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. Then try increasing the waiting period to 20 minutes. The goal is to lengthen the time between trips to the toilet until you're urinating every 2 to 4 hours.

Your doctor might instruct you to try timed urination if you urinate infrequently. You will urinate every 2 to 4 hours during waking hours, even if you feel as though you don't have to go. This method can be effective for both urge and stress incontinence.

Prompted voiding requires a caregiver to prompt the person to urinate. This technique is used mostly for people with a disability that gets in the way of using the bathroom on their own (functional incontinence).

Medicines

If exercise and behavioral therapies are not successful, your doctor might combine these treatments with medicines. (Taking a medicine by itself rarely cures incontinence.⁴)

• Anticholinergic medicines relax the bladder and increase bladder capacity. Examples include oxybutynin and tolterodine. These medicines are most frequently prescribed for urge incontinence. They often are effective, but they can cause side effects, including dry mouth, constipation, blurred vision, and an inability to urinate. Newer medicines, including time-release and skin-patch formulas, may have fewer side effects.
• Certain antidepressant medicines may also be used to treat urge or stress incontinence. An antidepressant may be used in combination with an anticholinergic medicine.

Medical devices

A pessary is a rubber device that is inserted into the vagina until it touches the cervix. The pessary presses through the vaginal wall and supports the urethra. It also pinches the urethra closed to help retain urine in the bladder and decrease stress incontinence. Some women with stress incontinence use a pessary just during activities that are likely to cause urine leakage, such as jogging. But many pessaries can be worn all the time. If you use a pessary, watch for possible vaginal and urinary tract infections, and see your doctor regularly. See the Other Treatment section of this topic for information about other medical devices.

Surgery

Stress incontinence that does not respond to medicine or exercise therapy is often treated surgically. (Surgery is typically not done for urge incontinence.)

If there may be additional causes of incontinence (mixed incontinence), a complete evaluation and further testing may be done before surgery is considered.

Discuss with your doctor which symptoms the surgery is designed to treat. Other symptoms may remain after surgery. If you have mixed incontinence, surgery may cure stress incontinence, but it may not improve urge incontinence. It may even make urge incontinence worse.

The tension-free vaginal tape (TVT) surgery is often used for stress incontinence. During this surgery, a meshlike tape is positioned under the urethra like a sling or a hammock to support it and return it to its normal position. The surgeon inserts the tape through small incisions in your vagina and pubic hair line. TVT surgery takes approximately 30 minutes and is usually done under local anesthesia. This surgery can also be done to correct incontinence that has come back after having another type of incontinence surgery. Another surgery called transobturator tape (TOT) surgery is like TVT surgery.

More invasive surgeries include the retropubic suspension surgery and the sling surgery. These surgeries support your pelvic organs and correct stress incontinence. Both require general anesthesia and hospitalization.

For women with stress incontinence who cannot have surgery, a simpler procedure called urethral bulking may be done. In this procedure, a urologist injects collagen or other bulking materials around the urethra to build up the urethra where it leaves the bladder. This procedure usually relieves symptoms for a short time, but you will probably need 2 or 3 injections.⁵

Which treatment for stress incontinence is right for me?

Treatment varies for less common types of urinary incontinence, such as overflow incontinence, total incontinence, functional incontinence, and anatomical incontinence.

What To Think About

Behavioral methods, exercises and lifestyle changes, and medicines are usually tried first before more invasive methods are tried to confirm the cause of incontinence. If the problem gets better, the diagnosis is confirmed. If the problem does not get better, your doctor may try another treatment or do more tests.

Incontinence can have more than one cause (mixed incontinence). When this is the case, the most significant cause is treated first, followed by treatment for the secondary cause, if needed.

Last updated:	September 17, 2008
Author:	Sandy Jocoy, RN
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Avery L. Seifert, MD - Urology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC