There are four categories of treatments: behavioral techniques, medications, medical devices, and surgery. Your doctor may want to begin with the behavioral approach, because it is the least invasive. However, treatment should be customized for each patient based on diagnosis, severity of condition, age, and ability to comply with treatment recommendations. Overactive bladder is often treated with medications, and stress incontinence is often treated surgically.
Two primary behavioral therapies are pelvic floor exercises and bladder retraining.
- For pelvic floor exercises, or Kegels, you should imagine that you are trying to stop your urine from flowing. You squeeze those muscles and hold for three seconds. Then you relax for three seconds, and then repeat. It's important not to tighten your abdominal, leg, or buttock muscles. And because it is easy to perform Kegels incorrectly, it's a good idea to have your doctor or a qualified therapist check your technique.
- For bladder retraining, you empty your bladder at set intervals, gradually lengthening the time between trips to the toilet. You are training the bladder to hold more urine, resisting the urge to urinate.
Treatment of OAB is focused on reducing bladder spasms and increasing bladder capacity. Typically, doctors recommend a combination of behavioral techniques and medications to achieve greater effect in a short time. These include:
- Reduction of fluid intake
- Reduction of bladder stimulants and irritants, including caffeine and alcohol
- Pelvic floor exercises (Kegels)
- Pelvic floor physical therapy, including biofeedback and electrical stimulation, to improve the muscles and nerves of the pelvis
- Bladder retraining
- Anticholinergic medications such as Detrol, Ditropan, Oxytrol, Vesicare, Enablex, and Sanctura (side effects include dry mouth, constipation, and headache)
Patients who don't respond well to the traditional noninvasive treatments may benefit from neuromodulation techniques, including peripheral acupuncture. Some doctors are experimenting with injecting Botox® into the bladder, but this has not been approved by the Food and Drug Administration.
Stress urinary incontinence
Treatment of SUI is focused on improving support of the bladder neck. Treatments include:
- Pelvic floor exercises (Kegels)
- Pelvic floor physical therapy, including biofeedback and electrical stimulation, to improve the muscles and nerves of the pelvis and improve support of the bladder neck and urethra
- Pessaries. A pessary is a stiff ring that a woman inserts into her vagina to help hold up the bladder. It needs to be regularly removed for cleaning.
- Surgery. More than 100 different surgical procedures have evolved for the treatment of stress urinary incontinence, but the most popular procedure currently performed is the suburethral sling, which can often be performed on an outpatient basis with IV sedation and local anesthesia. This is a vaginal technique that places a small, permanent piece of mesh or tape underneath the urethra to act as a hammock and prevent movement during activity. Supporting the bladder neck with such a sling can cure stress-related incontinence. An office-based treatment using radio-frequency to “treat” the weakened tissue around the bladder neck (Renessa procedure) is also available for patients with mild incontinence.
In cases of mild stress incontinence, pelvic floor exercises and physical therapy may result in significant improvement. In cases of moderate to severe incontinence, surgery is the best option. Over the past decade, surgery has evolved to become a safe and effective outpatient procedure, with success rates greater than 90 percent and complication rates less than 5 percent.
Anatomical urinary incontinence is treated surgically.
Functional urinary incontinence might be treated with a bedside commode or urinary catheterization.
Last reviewed on 1/29/10