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Treatments and drugs
By Mayo Clinic staffYour doctor is likely to 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 to address those conditions.
Behavioral therapies
Behavioral therapies may help you eliminate or lessen episodes of stress incontinence. The stress incontinence treatments your doctor will recommend may cover the following areas:
- Fluid consumption. Your doctor may recommend the amount and timing of fluid consumption during the day. You should also avoid caffeinated and alcoholic beverages.
- Healthy lifestyle changes. Quitting smoking or losing weight may lessen your vulnerability to stress incontinence and improve symptoms if you do have stress incontinence.
- Scheduled toilet trips. Your doctor may recommend a schedule for toileting. More frequent voiding of the bladder may reduce the number or severity of stress incontinence episodes.
- Pelvic floor muscle exercises. Exercises called Kegels strengthen your pelvic floor muscles and urinary sphincter. Your doctor or a physical therapist can help you learn how to do these exercises correctly. How well Kegels will work for you depends on your willingness to perform the exercises regularly, just like any other exercise routine.
Devices
Certain devices designed for women may help control stress incontinence, including:
- Vaginal pessary. This ring-shaped device, fitted and put into place by your doctor or nurse practitioner, helps support your bladder to prevent urine leakage. A vaginal pessary may be a good choice if you wish to avoid surgery.
- Urethral plug. This small tampon-like disposable device inserted into the urethra acts as a plug to prevent leakage. It's usually used to prevent incontinence during a specific activity.
Surgery
Surgical interventions to treat stress incontinence are generally designed to improve closure of the sphincter or support the bladder neck. Surgical interventions include:
- Injectable bulking agents. Collagen, synthetic sugars or gels may be injected into tissues around the upper portion of the urethra. These materials increase pressure on the urethra, improving the closing ability of the sphincter. Because this intervention is relatively noninvasive and inexpensive, it may be an appropriate treatment alternative to try before other surgical options.
- Open retropubic colposuspension. This procedure is often used to treat women with stress incontinence. Sutures attached either to ligaments or to bone lift and support tissues near the bladder neck and upper portion of the urethra.
- Sling procedure. In this procedure most often performed for women, the surgeon uses the person's own tissue or a synthetic material to create a "sling" that supports the urethra. Slings for men are used less frequently, but this surgical approach is under investigation. A recently developed technique using a mesh sling has proved effective in easing symptoms of stress incontinence in 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. If the device is implanted in a woman, the pump is in the labia.
References
- DuBeau CE. Clinical presentation and diagnosis of urinary incontinence. http://www.uptodate.com/home/index.html. Accessed Sept. 9, 2008.
- DuBeau CE. Patient information: Urinary incontinence. http://www.uptodate.com/patients/content/topic.do?topicKey=~/0j/LeBKevVnHo. Accessed Sept. 9, 2008.
- Urodynamic testing. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/urodynamic/index.htm. Accessed Sept. 9, 2008.
- Norton P, et al. Urinary incontinence in women. The Lancet. 2006;367(9504):57-67.
- Holroyd-Leduc JM, et al. Management of urinary incontinence in women: Scientific review. Journal of the American Medical Association. 2004;291(8):986-995.
- Norton PA. Female urinary incontinence: Epidemiology and evaluation. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:870-876.
- DuBeau CE. Patient information: Urinary incontinence treatments. http://www.uptodate.com/patients/content/topic.do?topicKey=~aup1.o0ho/j5Wk. Accessed Sept. 9, 2008.
- Baharak A, et al. Nonsurgical management of urinary incontinence and overactive bladder. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:890-899.
- Rogers RG. Urinary stress incontinence in women. The New England Journal of Medicine. 2008;358(10):1029-1036.
- Nager CW, et al. Operative management of urinary incontinence. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:877-889.
- Costa P, et al. Advancing the treatment of stress urinary incontinence. BJU International. 2006;97(5):911-915.
- Khan F, et al. Surgical treatment of stress urinary incontinence in women. http://www.uptodate.com/home/index.html. Accessed Sept. 9, 2008.
- Urodynamic testing. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/uimen/index.htm. Sept. 9, 2008.
- Rapp DE, et al. Surgical technique using AdVance sling placement in the treatment of post-prostatectomy urinary incontinence. International Brazilian Journal of Urology. 2007;33:231-237.
- Wolter CE (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 6, 2008.
