Current treatments can address a variety of causes of urinary incontinence, and symptoms can be successfully managed so people with urinary incontinence can live a normal, active life.
Treatment plans are based on medical history, type and severity of incontinence, coexisting conditions, and a patient's response to prior treatments. The most effect treatment plans for urinary incontinence include a multifaceted approach that not only addresses symptoms of urinary incontinence but identifies and treats all the possible co-existing conditions that can cause or worsen symptoms of urinary incontinence.
Other facets of treatment include minimizing alcohol and caffeine consumption, because both of these substances increase urinary production, frequency and sensations of urgency. Other behavioral interventions can include bladder training, emptying the bladder on a regular schedule, effective timing of fluid intake, and pelvic muscle exercises, known as Kegel exercises. In addition, recent research has found that overweight women who lose weight can dramatically lesson their risk of developing incontinence or lesson the symptoms of incontinence. Treatment may also include the use of medications that relax the bladder.
In some cases of urinary incontinence that does not better with other treatments, surgery may be an option. Surgery can help women whose incontinence is due to a bladder that has shifted out of its normal position. This commonly occurs due to pregnancy and childbirth. Surgery involves creating a sling or other type of internal support for the bladder. Some surgical procedures can be done on an outpatient basis.
The list of treatments mentioned in various sources for Urinary Incontinence includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
Alternative treatments or home remedies that have been listed as possibly helpful for Urinary Incontinence may include:
The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Urinary Incontinence may include:
Hidden causes of Urinary Incontinence may be incorrectly diagnosed:
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Possibly curable types of Urinary Incontinence may include:
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Some of the different medications used in the treatment of Urinary Incontinence include:
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It depends on what kind of bladder control problem you have. Hormone medicines are only one treatment. Your health care team may also recommend some of the following:
Incontinence is treatable and often curable at all ages. If you experience incontinence, you may feel embarrassed. It may help you to remember that loss of bladder control can be treated. You will need to overcome your embarrassment and see a doctor to learn if you need treatment for an underlying medical condition. (Source: excerpt from Urinary Incontinence in Women: NIDDK)
Exercises
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage. Women of all ages can learn and practice these exercises, which are taught by a health care professional.
Most Kegel exercises do not require equipment. However, one technique involves the use of weighted cones. For this exercise, you stand and hold a cone-shaped object within your vagina. You then substitute cones of increasing weight to strengthen the muscles that help keep the urethra closed.
Electrical Stimulation
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.
Biofeedback
Biofeedback uses measuring devices to help you become aware of your body's functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
Timed Voiding or Bladder Training
Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Biofeedback and muscle conditioning--known as bladder training--can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.
Medications
Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally.
Some of these medications can produce harmful side effects if used for long periods. In particular, estrogen therapy has been associated with an increased risk for cancers of the breast and endometrium (lining of the uterus). Talk to your doctor about the risks and benefits of long-term use of medications.
Pessaries
A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.
Implants
Implants are substances injected into tissues around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. Collagen (a fibrous natural tissue from cows) and fat from the patient's body have been used. Implants can be injected by a doctor in about half an hour using local anesthesia.
Implants have a partial success rate. Injections must be repeated after a time because the body slowly eliminates the substances. Before you receive collagen, a doctor must perform a skin test to determine whether you would have an allergic reaction to the material.
Surgery
Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success.
Most stress incontinence results from the bladder dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.
For severe cases of stress incontinence, the surgeon may secure the bladder with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage.
In rare cases, a surgeon implants an artificial sphincter, a doughnut-shaped sac that circles the urethra. A fluid fills and expands the sac, which squeezes the urethra closed. By pressing a valve implanted under the skin, you can cause the artificial sphincter to deflate. This removes pressure from the urethra, allowing urine from the bladder to pass.
Catheterization
If you are incontinent because your bladder never empties completely (overflow incontinence) or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. Catheters may be used once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use a long-term (or indwelling) catheter, you should watch for possible urinary tract infections.
Other Procedures
Many women manage urinary incontinence with pads that catch slight leakage during activities such as exercising. Also, you often can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.
Finally, many women who could be treated resort instead to wearing absorbent undergarments, or diapers--especially elderly women in nursing homes. This is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are an elderly woman, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding, pelvic muscle exercises, and electrical stimulation before resorting to absorbent pads or undergarments. (Source: excerpt from Urinary Incontinence in Women: NIDDK)
Treatments include waiting, dietary modification, moisture alarms, medications, and bladder training. (Source: excerpt from Urinary Incontinence in Children: NIDDK)
Nighttime incontinence may be treated by increasing ADH levels. The hormone can be boosted by a synthetic version known as desmopressin, or DDAVP. Users, including children, spray a mist containing desmopressin into their nostrils, where the drug enters the bloodstream. Researchers are developing a pill version of this drug.
Another medication, called imipramine, is also used to treat sleepwetting. It acts on both the brain and the urinary bladder. Unfortunately, total dryness with either of the medications available is achieved in only about 20 percent of patients.
If a young person experiences incontinence resulting from an overactive bladder, a doctor might prescribe a medicine that helps to calm the bladder muscle. This medicine controls muscle spasms and belongs to a class of medications called anticholinergics. (Source: excerpt from Urinary Incontinence in Children: NIDDK)
Bladder training consists of exercises for strengthening and coordinating muscles of the bladder and urethra, and may help the control of urination. These techniques teach the child to anticipate the need to urinate and prevent urination when away from a toilet. Techniques that may help nighttime incontinence include
Techniques that may help daytime incontinence include
At night, moisture alarms can wake a person when he or she begins to urinate. These devices include a water-sensitive pad worn in pajamas, a wire connecting to a battery driven control, and an alarm that sounds when moisture is first detected. For the alarm to be effective, the child must awaken or be awakened as soon as the alarm goes off. This may require having another person sleep in the same room to awaken the bedwetter. (Source: excerpt from Urinary Incontinence in Children: NIDDK)
Exercising your pelvic floor muscles for just 5 minutes, three times a day can make a big difference to your bladder control. Exercise strengthens muscles that hold the bladder and many other organs in place. (Source: excerpt from Exercising Your Pelvic Muscles: NIDDK)
You should tighten the two major muscles that stretch across your pelvic floor. They are the "hammock" muscle and the "triangle" muscle. Here are three methods to check for the correct muscles.
| You can make these pelvic floor muscles stronger with a few minutes of exercise every day. | |
Your treatment will depend on the type of bladder control problem you have. Some treatments are simple. Others are more complicated. The simplest treatments for women include pelvic muscle exercises. You can learn simple exercises that can strengthen the muscles near the urethra. These are called pelvic muscle exercises or Kegel exercises and take only a few minutes a day. Also, bladder training, weight loss and reduction of foods with caffeine and alcohol in your diet may all help some types of incontinence. Another level of treatment for muscle therapy may include electrical stimulation to make the muscles stronger and tighter, or biofeedback which takes the guesswork out of pelvic muscle exercise. A therapist places a patch over the muscles. A wire connects the patch to a TV screen. You watch the screen to see if you are exercising the right muscles. The therapist will help you. Soon you learn to control these muscles without the patch or screen. Then, there are medical treatments. Certain drugs can tighten or strengthen urethral and pelvic floor muscles. Other medicines can calm overactive bladder muscles. There is the option of collagen injections as well: Collagen (CALL-uh-jen) is a natural substance like fat. It can be injected into the tissue around your urethra to add bulk and keep your sphincter muscles tightly closed. One drawback to this treatment is that collagen breaks down after several months, so you may need to have injections repeated. Devices can also be inserted into the urethra or pads placed over the urethra to block urine flow.
Some bladder control problems can be solved by surgery, depending on what is causing the problem. In most cases, the surgeon changes the position of the bladder and urethra. After the operation, the bladder control muscles work better. (Source: excerpt from Urinary Incontinence: NWHIC)
If you are having trouble with incontinence, see your doctor. Even if it can't be completely cured, modern products and ways of managing incontinence can ease its discomfort and inconvenience. (Source: excerpt from Urinary Incontinence -- Age Page -- Health Information: NIA)
Treatment of urinary incontinence should be designed to meet your needs. As a general rule, the least dangerous procedures should be tried first. The many options include:
If your incontinence cannot be cured, it can be managed in several ways.
Remember, under a doctor's care, incontinence can be treated and often cured. Even if treatment is not fully successful, careful management can help. (Source: excerpt from Urinary Incontinence -- Age Page -- Health Information: NIA)
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