Treatment

Your doctor may 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 treatment for the condition.

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. Called Kegel exercises, these movements 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.

    A technique called biofeedback can be used along with Kegel exercises to make them more effective. Biofeedback involves the use of pressure sensors or electrical stimulation to reinforce the proper muscle contractions.

  • Fluid consumption. Your doctor might recommend the amount and timing of fluids you consume during the day and evening. However, don't limit what you drink so much that you become dehydrated.

    Your doctor may also suggest that you avoid caffeinated and alcoholic beverages because it's believed that in some people these dietary irritants affect your bladder function. But, new research suggests that coffee and caffeine may not increase stress incontinence. If you find that using fluid schedules and avoiding dietary irritants significantly improves leakage, you'll have to decide whether these changes are worth the improvement in leakage.

  • Healthy lifestyle changes. Quitting smoking, losing excess weight or treating a chronic cough will lessen your risk of stress incontinence as well as improve your symptoms.
  • Bladder training. Your doctor might recommend a schedule for toileting (bladder training) if you have mixed incontinence. More frequent voiding of the bladder may reduce the number or severity of urge incontinence episodes.

Medications

There are no approved medications to specifically treat stress incontinence in the United States. The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence in Europe, however.

Symptoms quickly return when the drug is stopped. Nausea is the most common side effect that makes people stop taking the medication.

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. Pessaries are used mostly in people who also have pelvic organ prolapse.

  • 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. Urethral inserts are generally used only for heavy activity, such as repeated lifting, running or playing tennis.

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's not a permanent repair. Multiple injections are required for most people.

  • 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.
  • 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 mild stress incontinence. The technique may ease symptoms of stress incontinence in some men.

  • Inflatable artificial sphincter. This surgically implanted device is primarily 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.
April 20, 2017
References
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