Treatments and drugs

By Mayo Clinic Staff

Your doctor will likely recommend a combination of treatment strategies to end or lessen the number of incontinence episodes. If an underlying cause or contributing factor, such as a urinary tract infection, is identified, you'll also receive treatments for those conditions.

Behavior therapies

Behavior therapies may help you eliminate or lessen episodes of stress incontinence. The treatments your doctor recommends may include:

  • Pelvic floor muscle exercises. Kegel exercises are the most important part of preventing and treating urinary incontinence. These exercises strengthen your pelvic floor muscles and urinary sphincter. Your doctor or a physical therapist can help you learn how to do them correctly. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly.
  • Fluid consumption. Your doctor might recommend the amount and timing of fluid consumption during the day. You may be requested to avoid caffeinated and alcoholic beverages to determine if these dietary irritants affect your bladder function. If your leakage is significantly improved by fluid schedules and avoiding dietary irritants, you'll have to decide if changing your fluid consumption or giving up coffee is worth the improvement in leakage.
  • Healthy lifestyle changes. Quitting smoking, losing unhealthy weight or treating a chronic cough will lessen your risk of stress incontinence as well as improve your symptoms.
  • Scheduled toilet trips. Your doctor might recommend a schedule for toileting (bladder retraining) if you have mixed incontinence. More frequent voiding of the bladder may reduce the number or severity of urge incontinence episodes.

Devices

Certain devices designed for women may help control stress incontinence, including:

  • Vaginal pessary. A specialized urinary incontinence pessary, shaped like a ring with two bumps that sit on each side of the urethra, is fitted and put into place by your doctor or nurse. It helps support your bladder base to prevent urine leakage during activity, especially if your bladder has dropped (prolapsed). This is a good choice if you wish to avoid surgery. A pessary will require routine removal and cleaning.
  • Urethral inserts. This small tampon-like disposable device inserted into the urethra acts as a barrier to prevent leakage. It's usually used to prevent incontinence during a specific activity, but it may be worn throughout the day. Urethral inserts aren't meant to be worn 24 hours a day.

Surgery

Surgical interventions to treat stress incontinence are designed to improve closure of the sphincter or support the bladder neck. Surgical options include:

  • Injectable bulking agents. Synthetic polysaccharides or gels may be injected into tissues around the upper portion of the urethra. These materials bulk the area around the urethra, improving the closing ability of the sphincter. Because this intervention is relatively noninvasive, it may be appropriate to consider before other surgical options. However, it is not a permanent repair.
  • Retropubic colposuspension. This surgical procedure — done laparoscopically or by abdominal incision — uses sutures attached either to ligaments or to bone to lift and support tissues near the bladder neck and upper portion of the urethra. This is often used in combination with other procedures to treat women with stress incontinence who also have a bladder that has dropped down (prolapsed).
  • Sling procedure. This is the most common procedure performed in women with stress urinary incontinence. In this procedure, the surgeon uses the person's own tissue, synthetic material (mesh), or animal or donor tissue to create a sling or hammock that supports the urethra. Slings are also used for men with sphincteric leakage. The technique uses a mesh sling and may ease symptoms of stress incontinence in some men.
  • Inflatable artificial sphincter. This surgically implanted device is more often used to treat men. A cuff, which fits around the upper portion of the urethra, replaces the function of the sphincter. Tubes connect the cuff to a pressure-regulating balloon in the pelvic region and a manually operated pump in the scrotum. While rarely used in the U.S. in women, if the device is implanted in a woman, the pump is in the labia.
Feb. 07, 2013