Treatments for Urinary Incontinence

There are a number of ways to treat incontinence. Your health care provider will work with you to figure out which way(s) is best for you. Don't give up or be embarrassed! Remember, many women have incontinence and all types of incontinence can be treated, no matter what your age.

Treatments include:

• Pelvic muscle exercises - Simple exercises to strengthen the muscles near the urethra, also called Kegel exercises. Taking a few minutes each day to do these exercises can help to reduce or cure stress leakage. A health care provider can teach you these exercises, most of which require no special equipment. One exercise, however, does use cones of different weights. You stand and hold a cone-shaped object inside your vagina. You then substitute cones of increasing weight to strength the muscles that 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. Special devices called electrodes are temporarily placed inside the vagina or rectum to stimulate nearby muscles. This treatment can be used to reduce both stress incontinence and urge incontinence.
• Biofeedback - Biofeedback used measuring devices to help you become aware of your body's functioning. A therapist trained in biofeedback places an electrical patch over your bladder and urethral muscles. A wire connected to the patch is linked to a TV screen. You and your therapist watch the screen to track when these muscles contract, so you can learn to gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress incontinence and urge incontinence.
• Timed Voiding or Bladder Training - Two techniques that help you to train your bladder to hold urine better. In timed voiding (urinating), you fill in a chart of when you urinate and when you leak urine. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Bladder training---biofeedback and muscle conditioning---can change your bladder's schedule for storing and emptying urine. These techniques are effective for urge incontinence and overflow incontinence.
• Weight Loss - Extra weight can cause bladder control problems. If you are overweight, talk with your health care provider about a diet and exercise program to help you lose weight.
• Dietary Changes - Certain foods and drinks can cause incontinence, such as caffeine (in coffee, soda, chocolate), tea, and alcohol. You can often reduce incontinence by restricting these liquids in your diet.
• Medicines - Medications can reduce many types of leakage. They can also help tighten or strengthen pelvic floor muscles and muscles around the urethra. Some drugs can also calm overactive bladder muscles. Some drugs, especially hormones such as estrogen, are believe to cause muscles involved in urination to function normally.
  
  Be aware that some drugs can produce harmful side effects if used for long periods of time. In particular, estrogen therapy can increase a person's risk for cancers of the breast and endometrium (lining of the uterus). Talk to your provider about the risks and benefits of medications.
• Implants - Substances are injected (through a needle) into tissues around the urethra. The implant adds bulk and helps the urethra to stay closed. This treatment reduces stress incontinence. Collagen (a natural fibrous tissue from cows) and fat from a person's body have been used. This procedure takes about 30 minutes and can be done in a provider's office using local anesthesia.
  
  The success rate of implants varies. Injections must be repeated after a time because the body slowly gets rids of the substances. Before getting a collagen injection, you need to have a skin test to make sure you are not allergic to this substance.
• Surgery - This treatment is primarily used only after other treatments have been tried. Different types of surgery can be done, depending on what kind of incontinence problem you have. Some surgeries raise, or lift, the bladder up to a more normal position. Other surgeries use implants to help the bladder function better.
• Catheterization - A catheter is a small tube that you can learn to insert yourself through the urethra into the bladder to drain urine. Catheters can be used once in while or all the time. If used all the time, the tube connects to a bag that you can attach to your leg. If you use a long-term (or indwelling) catheter, you need to watch for signs of urinary tract infection.
• Pessary - A pessary is a stiff ring that is inserted by a health care provider into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps to hold up the bladder and reduce stress leakage. If you use a pessary, watch for signs of vaginal and urinary tract infections. Visit your provider right away if you think you have an infection. Have your provider check the pessary on a regular basis.
• Urethral Inserts - A urethral insert is a small device that you place inside the urethra, a technique that you can learn to do yourself. You remove the device when you go to the bathroom and then put it back into your urethra until you need to urinate again.
• Urine Seals - Urine seals are small foam pads that you place over the urethra opening. The pad seals itself against your body, keeping you from leaking. You remove and throw it away after urinating. You then place a new seal over the urethra.
• Dryness Aids - Absorbent pads or diapers help many women, but they do not cure bladder control problems. They can also cause low self-esteem (how you feel about yourself) and irritate the skin. Some women use urinals (pans) beside their beds when they sleep if they suffer from urge incontinence.