Treating Urinary Incontinence

Treatment of Urinary Incontinence

Treatment for urinary incontinence depends on the type of incontinence (for example, urge or stress incontinence).^[12] The method used may be conservative such as behavioral methods or physical therapy or it may be a more aggressive method such as surgery. Your doctor will decide what the best approach is. Typically, a conservative method, perhaps involving Kegel exercises, will be tried first and if it doesn't work, a more aggressive method, which might include a medicine, will be used.

Behavioral Methods

Possible behavioral methods to treat urinary incontinence include:^[12]

• Bladder training. This method can be used alone or with other methods. It involves learning to delay urinating until after you get the urge to go. Initially, you might be asked to delay for 10 minutes. Over time, you may be able to delay for up to two or four hours. This training may also involve double voiding. This is used for people who have overflow incontinence. Here, you learn to try to urinate again a few minutes after you first go. Finally, you may be taught how to control urges to urinate. You will be given methods to distract yourself when you first feel the urge to urinate.

• Scheduled toilet trips. With this method, you will learn to time your trips to the toilet and control urination.

• Fluid and diet management. It may be possible to modify your diet to control the frequency of trips to the toilet. You may have to cut back on alcohol, caffeine or acidic foods. Reducing the amount of liquid you drink, losing weight or increasing physical activity may be helpful too.

• Biofeedback. Biofeedback provides you with information on how you are performing when trying to control urination. You will learn to recognize the muscles you use for control and learn to better control urination.

Physical therapy

Physical therapy may be an effective treatment for urinary incontinence.12 Your doctor may ask you to do pelvic floor muscle exercises or Kegel exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles (the muscles that control urination). These exercises can help stress and urge incontinence.

It can be difficult to figure out where the pelvic floor muscles are. The easiest way to do this is try to stop urinating.16 The muscles you use to do this are the correct ones. Don't make it a habit to stop urination. This can actually make the muscles weaker. But you can practice tightening and loosening these muscles at other times. This will help you control urinary incontinence. Tighten the muscles for 3 seconds and then release them for 3 seconds. Repeat this 10 times. Over time try to build up how long you can hold the contraction up to 10 seconds. Relax the muscles for the same amount of time you tighten them. Do a set of 10 exercises (one set is tightening the muscles once and relaxing them once) 3 times a day.

Medicine

Medicine can be used in conjunction with behavioral therapy to help treat urinary incontinence.^[12] Some categories of medicines used are:

• Anticholinergics. These medicines can calm an overactive bladder and can help with urge incontinence. Some of these drugs are Oxybutynin (Ditropan), Tolterodine (Detrol), Darifenacin (Enablex), Solifenacin (Vesicare) and Trospium (Sanctura).

• Topical estrogen. The use of a low-dose estrogen cream, ring or patch can be helpful for women who have low estrogen due to menopause or hysterectomy. Many brands are available. Discuss this with your doctor. Potential side effects include an increased risk of endometrial cancer (a cancer of the lining of the uterus).^[17] Blood clots are possible and could lead to stroke or heart attack. There is a low risk of breast cancer. If you experience headache (sudden or severe), loss of coordination, chest pain or pain in your legs, shortness of breath, slurred speech or weaknesses or numbness in your limbs, contact your doctor immediately. Other side effects are possible. Discuss possible side effects with your doctor before using this medicine.

• Imipramine. This is a type of antidepressant that can be helpful in treating mixed incontinence (urge and stress).

Surgery

When other methods don't work, surgery may be used to treat urinary incontinence.^[12] The more common procedures used are:

• Artificial urinary sphincter. This involves inserting a small device around the neck of the bladder and is used in men are incontinent from treatment of prostate cancer or an enlarged prostrate.

• Sling procedures. This involves placing your own tissue or a synthetic material around the bladder neck and urethra. The material acts like a sling to keep the urethra closed. This technique is effective for stress incontinence.

• Bladder neck suspension. This procedure provides support to the urethra and bladder neck. It requires general or spinal anesthesia. Recovery takes about six weeks.

Surgery for urinary incontinence has some risks.^[18] Be sure to discuss this thoroughly with your doctor before going forward with surgery. Some of the risks are:

• Difficulty urinating or inability to completely empty your bladder

• Getting overactive bladder, including urge incontinence

• Pelvic organ prolapse (having organs fall or slip out of place)

• Urinary tract infection

• Painful intercourse