The choice of treatment will depend on how severe the symptoms are, and how much they interfere with your lifestyle. There are three main treatment approaches for urge incontinence: medication, retraining, and surgery.
See also: When you have urinary incontinence
If you have an infection, your health care provider will prescribe antibiotics.
Medications used to treat urge incontinence relax bladder contractions and help improve bladder function. There are several types of medications that may be used alone or together:
- Anticholinergic medicines help relax the muscles of the bladder. They include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), and solifenacin (Vesicare).
- These are the most commonly used medications for urge incontinence. They are available in a once-a-day formula that makes dosing easy and effective.
- The most common side effects of these medicines are dry mouth and constipation. People with narrow-angle glaucoma cannot use these medications.
- Flavoxate (Urispas) is a drug that calms muscle spasms. However, studies have shown that it is not always effective at controlling symptoms of urge incontinence.
- Tricyclic antidepressants (imipramine, doxepin) have also been used to treat urge incontinence because of their ability to "paralyze" the smooth muscle of the bladder. Possible side effects include:
- Blurred vision
- Dry mouth
Drink plenty of water:
- Drinking enough water will help keep odors away.
- Drinking more water may even help reduce leakage.
Some experts recommend controlling how much fluid you drink and using other therapies to manage urge incontinence. The goal of this program is to drink a little bit of fluid at a time throughout the day, so your bladder does not need to handle a large volume of urine at one time.
Do not drink large amounts of fluids with meals. Drink less than 8 ounces at one time. Sip small amounts of fluids between meals. Stop drinking fluids about 2 hours before bedtime. Avoid carbonated drinks
It also may help to stop eating foods that may irritate the bladder, such as:
- Highly acidic foods, such as citrus fruits and juices
- Spicy foods
Managing urge incontinence usually begins with a program of bladder retraining. Sometimes, electrical stimulation and biofeedback may be used with bladder retraining.
During bladder retraining, you become aware of patterns in your incontinence episodes. Then you relearn the skills you need to hold and release urine.
In bladder retraining, you set a schedule of times when you should try to urinate. You try to hold in urination between these times.
One method is to force yourself to wait 1 to 1 1/2 hours between trips to the bathroom, even if you have any leakage or an urge to urinate in between these times. As you become better at waiting, gradually increase the time by 1/2 hour until you are urinating every 3 - 4 hours.
Pelvic muscle training exercises called Kegel exercises are mainly used to treat people with stress incontinence. However, these exercises may also help relieve the symptoms of urge incontinence.
The idea behind Kegel exercises is to strengthen the muscles of the pelvic floor to improve the function of the urethral sphincter. For Kegel exercises to work, you need to use the proper technique and stick to a regular exercise program.
Another approach is to use vaginal cones to strengthen the muscles of the pelvic floor. A vaginal cone is a weighted device that is inserted into the vagina. You tighten the pelvic floor muscles to hold the device the place. You hold the muscles for up to 15 minutes, twice daily. Within 4 - 6 weeks, about 70% of women who try this method have some symptom improvement.
BIOFEEDBACK AND ELECTRICAL STIMULATION
Biofeedback and electrical stimulation can help you find the right muscle group to work, to make sure you are performing Kegel exercises correctly.
Some therapists place a sensor in the vagina (for women) or the anus (for men) so they can tell when they are squeezing the pelvic floor muscles. A monitor will display a graph showing which muscles are squeezing and which are at rest. The therapist can help you find the right muscles for performing Kegel exercises.
Electrical stimulation uses low-voltage electric current to stimulate the correct group of muscles. The current may be delivered using an anal or vaginal probe. The electrical stimulation therapy may be performed in the clinic or at home. Treatment sessions usually last 20 minutes and may be done every 1 - 4 days.
Surgery can increase bladder storage and decrease pressure in the bladder. Surgery is only used for patients who are severely affected by their incontinence, and who have too many contractions and are not able to store much urine.
Augmentation cystoplasty is the surgery most often performed for severe urge incontinence. In this surgery, a segment of the bowel is added to the bladder to increase the bladder size and allow it to store more urine.
Possible complications include:
There is a risk of forming abnormal tube-like passages (urinary fistulae). These passages can lead to abnormal urine drainage, urinary tract infection, and difficulty urinating. Augmentation cystoplasty is also linked to a slightly increased risk of developing tumors.
Sacral nerve stimulation is a newer type of surgery. It uses an implanted unit to sends small electrical pulses to the sacral nerve. The electrical pulses can be adjusted to your symptoms.
People with urge incontinence may find it helpful to avoid activities that irritate the urethra and bladder, such as taking bubble baths or using harsh soaps in the genital area.
Urinary incontinence is a long-term (chronic) problem. Although you may be considered cured by treatment, continue to see your health care provider to evaluate your progress and monitor for possible treatment complications.