Urinary Incontinence

The first line of urinary incontinence treatment typically involves lifestyle changes to ease symptoms. Your provider may recommend:

• Eating more fiber to limit constipation
• Establishing a consistent bathroom schedule to promote better bladder control
• Limiting caffeine and alcohol
• Maintaining a healthy weight
• Managing conditions, such as diabetes, that can exacerbate incontinence symptoms
• Quitting smoking, as it can positively influence bladder function

Behavioral therapy focuses on your bathroom habits and patterns to help you gain better control over bladder function. Treatments include:

• Bladder training: This structured technique helps expand your bladder’s capacity by teaching you to gradually increase time between bathroom visits. Bladder training is particularly beneficial for those experiencing urge incontinence.
• Timed voiding: You establish and follow a set schedule for bathroom visits to help reduce the likelihood of accidents.
• Urgency suppression: Urgency suppression techniques include controlled breathing, distraction and pelvic floor exercises to counteract the urgent need to urinate. The practice gives you more control over your bladder responses.

Pelvic floor physical therapy, guided by specialized therapists, involves exercises to address specific muscle imbalances, weakness or tension that contribute to urinary incontinence. Your therapist will teach you exercises and use other specialized therapies to improve bladder control, including:

• Biofeedback: Sensors provide visual or auditory feedback on pelvic floor muscle activity to help improve your awareness of and control over these muscles.
• Electrical stimulation: Mild electrical pulses stimulate pelvic floor muscles to make them stronger and better able to control the flow of urine.
• Pelvic floor exercises: These exercises involve contracting and relaxing the pelvic floor muscles. Regular pelvic floor exercises, such as Kegels, can help you build muscle tone and endurance, providing better support for your bladder and reducing the risk of leaking.
• Vaginal cones: Vaginal cones are weighted devices placed in the vagina to strengthen pelvic floor muscles. Regular use helps build strength and stability of bladder and other pelvic floor muscles.

Incontinence pads and disposable diapers can help you manage incontinence without a prescription. However, you have other options if those do not work well for your lifestyle.

• Catheter: This thin tube is carefully inserted into the bladder to help drain urine.
• Pessary: A pessary is inserted into the vagina to offer structural support to the bladder and adjacent tissues. It can also address concerns related to pelvic organ prolapse and stress incontinence. 
• Urethral insert: A urethral insert is a soft balloon that can be inserted to prevent leaks and removed when you need to urinate.
• Vaginal insert: Similar to a tampon, this insert goes into the vagina and puts pressure on the urethra. The added pressure helps prevent leaks. You can purchase these over the counter.

In some cases, your provider will prescribe medications to address underlying causes of urinary incontinence. Those medications can include:

• Anticholinergics: Anticholinergic medications help control overactive bladder symptoms by blocking certain nerve signals, reducing bladder contractions and minimizing urgency.
• Mirabegron: Mirabegron is a medication that relaxes the bladder muscles, increasing the bladder’s capacity to hold urine and reducing symptoms of urgency and frequency.
• Topical estrogen: Topical estrogen, often in the form of creams or patches, may be recommended for postmenopausal women to address changes in the urethra and vaginal tissues, improving continence.

Interventional therapies offer more advanced options for managing urinary incontinence. They are often considered when lifestyle changes, devices and medications are insufficient.

• Botulinum toxin A injections: Botulinum toxin A injections can be administered into the bladder muscle, relaxing overactive muscles and alleviating symptoms of urgency and frequency.
• Bulking agents: Bulking agents are injected into tissues surrounding the urethra to add bulk and improve urethral closure, reducing leakage.
• Posterior tibial nerve stimulation: This treatment uses a small needle near the ankle to deliver electrical impulses, affecting nerves related to bladder function and improving symptoms.
• Sacral nerve stimulation: Sacral nerve stimulation involves implanting a device that regulates nerve signals to the bladder, promoting better control and reducing incontinence.

Your doctor may recommend surgery and other procedures for urinary incontinence that doesn’t respond to other treatments. Your options for surgery include:

• Artificial urinary sphincter: An artificial urinary sphincter is a surgically implanted device designed to control the flow of urine, providing enhanced control for people with severe incontinence.
• Bladder neck suspension: Bladder neck suspension involves repositioning and supporting the bladder neck and urethra, often done to address stress incontinence in women.
• Colposuspension: Colposuspension is a surgical procedure that involves lifting and supporting the bladder neck and urethra, enhancing continence.
• Prolapse surgery: In cases where pelvic organ prolapse contributes to incontinence, surgery to repair and support pelvic structures may be recommended.
• Sling surgery: Sling surgery uses a synthetic mesh sling to support the urethra, improving its closure and reducing stress incontinence.