Urinary Incontinence

Treatment

Mayo Clinic's comprehensive evaluation results in a precise diagnosis and the most appropriate treatment plan for your condition. Following treatment at Mayo Clinic, most people are either symptom-free, or their symptoms are significantly improved.

Because treatment for urinary incontinence varies for each person based on type, persistence and severity, Mayo Clinic specialists work with you to determine the treatment that best fits your lifestyle and health needs. Treatment options include:

Noninvasive Treatments

Behavioral modifications

Simple lifestyle or behavioral modifications are often the first therapy, and may be the only treatment necessary. These noninvasive approaches include:

• Modifying your diet
• Reducing liquids before bedtime
• Eliminating or adding medications

Pelvic floor muscle exercises (also known as Kegel exercises) strengthen the muscles around the urethra so that urine is less likely to leak, even under pressure. For people who have difficulty doing Kegel exercises, Mayo Clinic specialists use biofeedback and electrostimulation devices as training aids. These therapies require time, effort and commitment, but they do not have side effects and are often very effective.

Medications

Several medications treat incontinence by:

• Preventing unwanted bladder contractions
• Tightening the bladder or urethra muscles
• Relaxing bladder muscles

Devices

Mayo Clinic doctors routinely prescribe various devices to treat urinary incontinence. These options include:

• Pessary (PES-uh-re). This special device is inserted in the vagina to hold up the bladder and prevent leakage.
• Bladder neck support device. A prosthesis inserted in the vagina to elevate the bladder neck and restore normal positioning between the bladder and urethra.
• Urethral insert. A small plug inserted into the urethra and removed for urination.
• Urine seal. A small disposable foam pad placed over the urethra opening. This device is removed for urination and thrown away.
• Artificial urinary sphincter-men. A tiny, doughnut-shaped device inserted under the skin of the penis to close the urethra. By pressing a valve implanted under the skin, the artificial sphincter can be inflated to stop urine and deflated to allow urination.
• Artificial urinary sphincter-women. Replacing the sphincter of the female urethra is often valuable for women who have had multiple unsuccessful surgeries. By pressing a valve implanted under the skin, the artificial sphincter can be inflated to stop urine and deflated to allow urination.

Interventional therapies

Bulking agents

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Bulking agents (space-filling substances) are used mainly to treat stress incontinence. Collagen and other materials can be injected into the tissue around the urethra to keep the sphincter muscles closed to stop urine from leaking — like adding a washer to a leaky faucet. At Mayo Clinic, this is done as an outpatient procedure.

Botulinum toxin

Botulinum toxin (Botox) is sometimes injected into the muscles of the bladder to treat incontinence. Botox blocks the release of chemicals that cause muscle spasms. The injection, given under anesthesia, is effective for nine months to a year. This treatment is not approved by the Food and Drug Administration, so it is not usually covered by insurance.

Sacral nerve stimulation

A thin lead wire with a small electrode tip is surgically placed near the sacral nerve (in the lower spine), which controls voiding function. A nerve stimulator then sends small electrical impulses continuously to the sacral nerve. The impulses act as a bladder pacemaker, reducing or eliminating urge incontinence in a high percentage of people.

Surgery

When other options fail, surgery remains an excellent choice for treatment of urinary incontinence. It is often needed to remove blockages, change the position of the bladder, add bulk to tissues or add support to severely weakened pelvic muscles. In some cases, the urinary sphincter may be replaced with an artificial one. Mayo Clinic specialists work with you to select the most appropriate treatment.

Suburethral slings

Suburethral slings are made of a synthetic mesh. The sling acts as a hammock under the urethra, compressing the urethra to prevent leaks that occur with activities of daily living. The minimally invasive suburethral sling procedure is performed most often at Mayo Clinic because it requires smaller incisions, has a faster recovery time and has a success rate similar to pubovaginal sling surgery. This procedure is also used with men who have incontinence after prostate surgery.

Pubovaginal fascial slings

A piece of fascia (flat, tough, tendonlike material) is wrapped around the bladder neck to keep urine in, even under stress. Mayo Clinic physicians report a success rate of over 90 percent using two slings from the patient's own tissue or from donated tissue (cadaveric).

Mayo Clinic surgeons take time to ensure that you are an appropriate candidate for sling surgery. Women with serious health problems, those who cannot tolerate surgery, or those with urge incontinence alone may not be appropriate candidates.

Enlarging the bladder

Also called bladder augmentation, this surgery uses a segment of intestine to enlarge the size of the bladder to cure incontinence. It is major abdominal surgery. Some people, especially those with underlying nerve damage, require lifelong use of a catheter after this procedure.

Reoperation

Mayo Clinic surgeons are experienced in repairing previous surgeries that have not achieved effective results. Mayo Clinic is also a regional referral center for people with fistulas (holes in the bladder that develop after a previous surgery).

Read more about incontinence treatment at MayoClinic.com.