Treatment depends on how severe your symptoms are and how much they affect your everyday life.
Your health care provider may ask you to stop smoking (if you smoke) and avoid caffeinated beverages (such as soda) and alcohol. You may be asked to keep a urinary diary, recording how many times you urinate during the day and night, and how often you leak urine.
There are four types of treatment for stress incontinence:
- Behavior changes
- Pelvic floor muscle training
Examples of behavior changes include:
- Drinking less fluid (if you drink more than normal amounts of fluid)
- Urinating more often to reduce the amount of urine that leaks
- Avoiding jumping or running, which can cause more urine to leak
- Making your bowel movements more regular by taking dietary fiber or laxatives to avoid constipation (which can make incontinence worse)
- Quitting smoking to reduce coughing and bladder irritation (and your risk of bladder cancer)
- Avoiding alcohol and caffeine, which can stimulate the bladder
- Losing weight if you are overweight
- Avoiding food and drinks that irritate the bladder, such as spicy foods, carbonated drinks, and citrus fruits
- Keeping blood sugar under control if you have diabetes
PELVIC FLOOR MUSCLE TRAINING
Pelvic muscle training exercises (called Kegel exercises) may help control urine leakage. These exercises keep the urethral sphincter strong and working properly.
Some women may use a device called a vaginal cone with pelvic exercises. You place the cone into the vagina. Then you try to squeeze the pelvic floor muscles to hold the cone in place. You can wear the cone for up to 15 minutes at a time, twice a day. Within 4 to 6 weeks, most women have some improvement in their symptoms.
Biofeedback and electrical stimulation may be helpful for people who have trouble doing pelvic muscle training exercises. These two methods can help you find the correct muscle group to work. Biofeedback can also help you learn how to control certain body responses.
Electrical stimulation therapy uses a low-voltage electrical current to stimulate and contract the correct group of muscles. The current is delivered using an anal or vaginal probe. The electrical stimulation therapy may be done at the health care provider's office or at home.
Treatment sessions usually last 20 minutes and may be done every 1 to 4 days. Newer techniques are being studied. One new technique uses an electromagnetic chair to make the pelvic floor muscles contract when the person is sitting.
Medicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include:
- Anticholinergic drugs control overactive bladder (oxybutynin, tolterodine, Enablex, Sanctura, Vesicare, Oxytrol)
- Antimuscarinic drugs block bladder contractions (many health care providers prescribe these types of drugs first)
- Alpha-adrenergic agonist drugs, such as phenylpropanolamine and pseudoephedrine (common ingredients in over-the-counter cold medications), help increase sphincter strength and improve symptoms in many patients. However, these drugs are rarely prescribed because of possible side effects on the heart.
- Imipramine, a tricyclic antidepressant, works much like the alpha-adrenergic and anticholinergic drugs
Estrogen therapy can be used to improve urinary frequency, urgency, and burning in women who have gone through menopause. It also can improve the tone and blood supply of the urethral sphincter muscles.
However, it is not clear whether estrogen treatment improves stress incontinence. Some hormone treatments given after menopause have been shown more harmful than helpful to women's health. Women who have a history of breast or uterine cancer usually should NOT use estrogen therapy to treat stress urinary incontinence.
Surgery is only recommended after the exact cause of urinary incontinence has been found. Most of the time, your health care provider will try bladder retraining or Kegel exercises before considering surgery.
Anterior vaginal repair or paravaginal repair procedures are often done in women when the bladder is bulging into the vagina (called a cystocele). Anterior repair is done through a surgical cut in the vagina. A paravaginal repair is done through a surgical cut in the vagina or abdomen.
Artificial urinary sphincter is a surgical device used to treat stress incontinence mainly in men (rarely in women).
Collagen injections make the area around the urethra thicker, which helps control urine leakage (the procedure may need to be repeated after a few months).
- Male sling is a newer procedure that can be done in certain men. It is easier to do than placing an artificial urinary sphincter.
- Retropubic suspensions are a group of surgical procedures done to lift the bladder and urethra. They are done through a surgical cut in the abdomen.
Tension-free vaginal tape
Vaginal sling procedures are often the first choice for treating stress incontinence in women (they are rarely done in men). A sling is placed that supports the urethra.
Most health care providers recommend that their patients try other treatments before having surgery.
Depending on the success of treatment and other medical problems you have, you may need a urinary catheter to drain urine from the bladder.