Treatment
Treatment for
urinary incontinence depends on the type of incontinence, the severity
of your problem and the underlying cause. Your doctor will recommend the
approaches that are best suited to your condition. Often a combination
of treatments is used. Most people treated for urinary incontinence see
a dramatic improvement in their symptoms.
Treatment options
for urinary incontinence fall into four broad categories behavioral
techniques, medications, devices and surgery.
Behavioral
techniques
Behavioral techniques and lifestyle changes work well for certain types
of urinary incontinence. They may be the only treatment you need.
Bladder training
may also involve double voiding urinating, then waiting a few minutes
and trying again. This exercise can help you learn to empty your bladder
more completely to avoid incontinence. In addition, bladder training may
involve learning to control urges to urinate. When you feel the urge to
urinate, you're instructed to relax breathe slowly and deeply or to
distract yourself with an activity.
Nighttime bladder
training may be reinforced with devices such as moisture alarms, which
wake you up when you begin to urinate. They are particularly helpful for
children who wet the bed at night. The devices consist of a
fluid-sensitive pad worn in pajamas, a wire connecting to a control, and
an alarm that sounds or vibrates when moisture is first detected.
Moisture alarms help children learn to awaken when their bladder is
full, in time to go to the bathroom.
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Scheduled
toilet trips.
This means timed urination going to the bathroom according to the
clock rather than waiting for the need to go. Following this
technique, you go to the toilet on a routine, planned basis, usually
every two to four hours.
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Pelvic
floor muscle exercises.
These exercises strengthen your urinary sphincter and pelvic floor
muscles the muscles that help control urination. Your doctor may
recommend that you do these exercises three or four times a day to
treat your incontinence. They are especially effective for stress
incontinence, but may also help urge incontinence.
To do pelvic floor
muscle exercises (Kegels), imagine that you're trying to stop from
passing gas. Squeeze the muscles you would use and hold for a count of
three. Relax, count to three again, then repeat. You can do these
exercises almost anywhere while you're driving, watching television or
sitting at your desk at work.
With Kegels, it
can be difficult to know whether you're contracting the right muscles.
In general, if you sense a pulling feeling when you squeeze, you're
using the right muscles. Men may feel their penis pull in slightly
toward their body. To double-check that you're contracting the right
muscles, try the exercises in front of a mirror. Your abdominal, buttock
or leg muscles shouldn't tighten if you're isolating the muscles of the
pelvic floor. You can also test yourself by trying to stop your urine
midstream, although most people with incontinence can't stop their urine
midstream, so don't lose hope if you can't. Another way to be sure
you're doing Kegels correctly is a simple finger test. Place a finger in
your anus or vagina (for women). Then squeeze around your finger. The
muscles you contract are your pelvic floor muscles.
If you're still
not sure whether you're contracting the right muscles, you can ask your
doctor for help. Your doctor can refer you to a physical therapist for
biofeedback techniques that will help you identify and contract the
right muscles.
After several
months of doing pelvic floor muscle exercises correctly, you should
notice improvement in your urinary control. To further strengthen their
urinary and pelvic floor muscles, women can use "vaginal weights." These
are tampon-shaped cones of increasing weight that women can insert into
their vaginas and try to hold in place.
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Electrical
stimulation.
In this procedure, electrodes are temporarily inserted into your
rectum or vagina to stimulate and strengthen pelvic floor muscles.
Gentle electrical stimulation can be effective for stress
incontinence and urge incontinence, but it takes several months and
multiple treatments to work.
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Fluid and
diet management.
In some cases, you can simply modify your daily habits to regain
control of your bladder. You may need to cut back on or avoid
alcohol or caffeine, if either cause you incontinence. If acidic
foods irritate your bladder, cutting back on such triggers may rid
you of your problem. For some people, reducing liquid consumption
before bedtime is all that's needed. Losing weight also may
eliminate the problem.
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Other
techniques.
For stress incontinence, contracting your urinary muscles to hold
urine in or crossing your legs at certain times such as when you
feel a sneeze coming may help significantly.
Medications
Many
times, urinary incontinence can be corrected with the help of
medication. Drugs commonly used to treat incontinence include:
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Anticholinergic (antispasmodic) drugs.
These prescription medications calm an overactive bladder, so they
may be helpful for urge incontinence. Examples include tolterodine (Detrol),
oxybutynin (Ditropan) and hyoscyamine (Levsin). These drugs can be
very effective at controlling incontinence, but a side effect is dry
mouth. To combat dry mouth, you may be tempted to drink more water.
But that may not help your incontinence. Your doctor may recommend
that you suck on a piece of candy or chew gum instead to produce
more saliva.
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Imipramine
(Tofranil).
This antidepressant may be used to treat incontinence. It causes the
bladder muscle to relax, while causing the smooth muscles at the
bladder neck to contract.
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Pseudoephedrine.
In the past, some doctors recommended medications that contain
pseudoephedrine (Dimetapp, Sudafed) to treat mild to moderate stress
incontinence. These cold medications slightly tighten the urinary
sphincter. However, these products can cause dangerous, rapid
heartbeats, so they're no longer used for incontinence.
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Hormone
replacement therapy.
After menopause, a woman's body produces less of the hormone
estrogen. This drop in estrogen can contribute to changes in the
skin lining the urethra and vagina, which can contribute to the
development of incontinence in some women. Applying estrogen in the
form of a vaginal cream, ring or patch may help relieve some of the
symptoms of incontinence in these women. Oral estrogen may not have
the same benefits as topical creams and ointments. Taking HRT as a
combination therapy estrogen plus progestin can result in
serious side effects and health risks. Work with your doctor to
evaluate the options and decide what's best for you.
In children,
nighttime incontinence may be due to a shortage of the nighttime
production of a hormone called antidiuretic hormone (ADH). This hormone
slows the making of urine. The body normally produces more ADH at night,
so the need to urinate is lower. If a child doesn't produce enough ADH
at night, the making of urine doesn't slow down and the bladder
overfills. If the child doesn't sense the bladder filling and awaken to
urinate, he or she wets the bed. A synthetic version of ADH known as
desmopressin (DDAVP) is available as a nasal spray or pill for children
to use before bedtime.
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Antibiotics.
If your incontinence is due to a urinary tract infection or an
inflamed prostate gland (prostatitis), your doctor can successfully
treat the problem with antibiotics.
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Others.
Your doctor may prescribe drugs that actually relax your urinary
sphincter or make your bladder contract more, depending on the
underlying cause of your incontinence.
If you're a man
with incontinence caused by an enlarged prostate gland, your doctor may
prescribe medications or other therapies to treat your condition. The
goal may be to relax muscles around your urethra so that you can urinate
with more control or to shrink the size of your prostate.
Drugs can be
effective at treating urinary incontinence. But they may have side
effects. Ask your doctor about what to expect from a treatment.
If a medication
you're taking such as a sedative is the cause of incontinence, your
doctor may lower the dosage or change the medication to relieve that
side effect.
Medical devices
Several
medical devices are available to help treat incontinence. They're
designed specifically for women and include:
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Urethral
inserts.
These are small, tampon-like disposable devices or plugs that a
woman inserts into her urethra the tube where urine exits the body
to prevent urine from leaking out. Urethral inserts aren't for
everyday use. They work best for women who have predictable
incontinence during certain activities, such as while playing
tennis. The device is inserted before the activity. Whenever the
woman needs to urinate, she simply removes the device. Urethral
inserts are available by prescription.
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Pessary.
Your doctor may prescribe a pessary a stiff ring that you insert
into your vagina and wear all day. The device helps hold up your
bladder, which lies near the vagina, to prevent urine leakage. You
need to regularly remove the device to clean it. You may benefit
from a pessary if you have incontinence due to a dropped (prolapsed)
bladder or uterus.
Surgery
If
other treatments aren't working, there are nearly 100 variations of
surgical procedures used to fix problems that cause urinary
incontinence. In men, surgery may be necessary to remove an enlarged
prostate gland that's constricting the urethra. Surgical removal of a
tumor in the bladder or a uterine fibroid also may eliminate
incontinence.
If your bladder or
uterus has slipped out of position, a surgeon can put the structure back
in place with a variety of techniques. Rarely, surgery to treat urinary
incontinence may involve enlarging the bladder or correcting a birth
defect. Or surgery may be needed to bolster weakened urinary sphincter
muscles.
Some of the more
common procedures include:
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Artificial
urinary sphincter.
This small device is particularly helpful for men who have weakened
urinary sphincters from treatment of prostate cancer or an enlarged
prostate gland, and it's rarely used for women with stress
incontinence. Shaped like a doughnut, the device is implanted around
the neck of your bladder. The fluid-filled ring keeps your urinary
sphincter shut tight until you're ready to urinate. To urinate, you
press a valve implanted under your skin that causes the ring to
deflate and allows urine from your bladder to be released. This
surgery can cure or greatly improve incontinence in more than 70
percent to 80 percent of men with incontinence. Complications
include malfunction of the device which means the surgery will
need to be repeated and infection, but infection is uncommon.
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Bulking
material injections.
Some women with stress incontinence benefit from urethral injections
of bulking agents. This procedure involves injecting bulking
materials usually animal or human collagen into the tissue
surrounding the urethra or the skin next to the urinary sphincter.
The injection tightens the seal of the sphincter by bulking up the
surrounding tissue. The procedure is done with minimal anesthesia
and typically takes about two to three minutes. It usually needs to
be repeated every six to 18 months, because the bulking agents that
are currently available don't remain effective over time. There is a
risk of rejection or infection, and the procedure is generally not
as effective as open surgery.
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Sacral
nerve stimulator.
This small device acts on nerves that control bladder and pelvic
floor contractions. The device, which resembles a pacemaker, is
implanted under the skin in your abdomen. A wire from the device is
connected to a sacral nerve an important nerve in bladder control
that runs from your lower spinal cord to your bladder. Through the
wire, the device emits electrical pulses that stimulate the nerve
and help control the bladder. The pulse doesn't cause pain and may
improve or cure 50 percent to 75 percent of people with
tough-to-treat urge incontinence or urinary retention leading to
overflow incontinence. Possible complications include infection, but
the device can be removed.
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Sling
procedure.
The most popular surgery for women with stress incontinence is the
sling procedure. During this procedure, a surgeon removes a strip of
abdominal tissue and places it under the urethra. Or the surgeon may
use a strip of synthetic material or a strip of tissue from a donor or cadaver. These strips act like a hammock, compressing
the urethra to prevent leaks that occur with the activities of daily
living.
The success of
your treatment depends on the right diagnosis. Talk to your doctor about
the specifics and possible complications of any treatment. Ask questions
and express concerns to help find out which treatment is right for you.
Absorbent pads and
catheters
If
medical treatments can't completely eliminate your incontinence or you
need help until a treatment starts to take effect you can try products
that help ease the discomfort and inconvenience of leaking urine.
Various absorbent
pads are available to help you manage urine loss. Most products are no
more bulky than normal underwear and can be worn easily under everyday
clothing. Men who have problems with dribbles of urine can use a drip
collector a small pocket of absorbent padding that's worn over the
penis and held in place by closefitting underwear. Men and women can
wear panty liners or pads in their underwear to collect urine. Adult
diapers are available in both disposable and reusable forms and come in
a variety of sizes. Some people find wearing plastic underwear over
their regular underwear helps keep them dry. Others opt for washable
underwear and briefs with waterproof panels. Incontinence products can
be purchased at drugstores, supermarkets and medical supply stores.
If you're
incontinent because your bladder doesn't empty properly, your doctor may
recommend that you learn to insert a soft tube (catheter) into your
urethra several times a day to drain your bladder. This may give you
more control, especially if you suffer from overflow incontinence.
In some cases
people have to keep a catheter in constantly. The catheter is connected
to an external bag to hold urine. As needed, the bag is emptied.
Prevention
Incontinence may
or may not be something you can prevent. Oftentimes the cause of
incontinence is out of your control.
However, you may
be able to decrease your risk of urinary incontinence by taking good
care of yourself and keeping or getting your weight under control.
Because pregnancy and childbirth can weaken the urinary sphincter and
pelvic floor muscles, doctors may advise pregnant women to do Kegel
exercises during pregnancy as a preventive step.
Avoiding or
limiting certain foods and drinks may help prevent incontinence. For
example, if you know that drinking more than two cups of coffee makes
you have to urinate uncontrollably, cutting back to one cup of coffee or
forgoing caffeine may be all that you need to do.
Including more
fiber in your diet or taking fiber supplements can help prevent
constipation, which can be a cause of incontinence. Your doctor may
recommend that you drink more or less water as a preventive measure,
depending on your bladder problem.
Urinary incontinence
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loss
of bladder control
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