Treatment options for urinary incontinence will vary depending on the patient’s age and overall health. The good news is there are more treatments for urinary incontinence today than ever before. These treatments may include:
- Behavioral therapies, or interventional therapies that aim to help people regain bladder control: These can include bladder training (in which people are taught to resist the urge to void their bladders and increase the time between urination) and toileting assistance (including scheduled toilet trips).
- Pelvic floor muscle exercises, which seek to improve the patient’s muscle tone and, hence, bladder control: These can include Kegel exercises (daily exercises of the pelvic muscles, which can especially help younger women), biofeedback (in which sensors are used to help make a patient more aware of his or her body’s signals, usually in conjunction with Kegel exercises), vaginal weight training (during which small weights are help in the vagina by tightening vaginal muscles) and pelvic floor electrical stimulation (wherein mild electrical pulses are used to stimulate muscle contractions).
- Medications, including: anticholinergenics (often used along with bladder training, these medications are primarily used to treat urge incontinence); estrogen replacement (especially in postmenopausal women), including topical estrogen creams; and duloxetine (which aids stress incontinence by strengthening the sphincter muscle). Imipramine, a tricyclic antidepressant, is used less frequently now, especially among older patients, as newer medications produce better results with fewer side effects. In 2011, the Food and Drug Administration approved the use of Botox to help people whose urinary incontinence stems from neurological conditions such as spinal cord injuries and multiple sclerosis.
- Medical devices, including: a pessary (a rubber device inserted into the vagina that pinches the urethra closed, helping to reduce stress incontinence), urethral insert (a thin, flexible, solid tube placed into the urethra that helps block urine leakage) and external urethral barrier (a self-adhesive patch placed over the urethral opening to prevent leakage).
- Surgery: Surgical options for stress incontinence usually begin with what’s called a sling procedure, which is used to compress the urethra. An artificial urinary sphincter involves the implantation of an artificial sphincter, and is usually used for men. A needle bladder neck suspension involves suturing the urethra to the pelvic floor; this is a relatively quick and easy procedure, but its long-term results are mixed. Sacral nerve stimulators, or devices that stimulate the sacral nerves (nerves near the tail bone) via electrical pulses, can help patients with urge incontinence. Bulking material injections, in which materials such as collagen are injected to support the urethra, are also an option.
- Diet management and fluid management: Eliminating alcohol and caffeine can help reduce symptoms of urinary incontinence, as these are diuretics that increase the urge to urinate frequently; preventing constipation by drinking lots of water eating foods high in fiber can also help.
For total incontinence, a catheter is used to empty the bladder regularly.