Treatments and drugs

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Treatment for urinary incontinence depends on the type of incontinence, the severity of your problem and the underlying cause. Your doctor will recommend the approaches best suited to your condition. Often a combination of treatments is used. Most people treated for urinary incontinence see a dramatic improvement in their symptoms.

Treatment options for urinary incontinence fall into four broad categories — behavioral techniques, medications, devices and surgery. In most cases, your doctor will suggest the least invasive treatments first, so you'll try behavioral techniques first and move on to other options only if these techniques fail.

The success of your treatment depends most of all on the right diagnosis. Talk to your doctor about the specifics and possible complications of any treatment. Ask questions and express concerns to help find out which treatment is right for you.

Behavioral techniques
Behavioral techniques and lifestyle changes work well for certain types of urinary incontinence. They may be the only treatment you need.

Pelvic floor muscle exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles — the muscles that help control urination. Your doctor may recommend that you do these exercises frequently to treat your incontinence. They are especially effective for stress incontinence, but may also help urge incontinence.

To do pelvic floor muscle exercises (Kegels), imagine that you're trying to stop your urine flow. Squeeze the muscles you would use and hold for a count of three. Relax, count to three again, then repeat. You can do these exercises almost anywhere — while you're driving, watching television or sitting at your desk at work.

With Kegels, it can be difficult to know whether you're contracting the right muscles and in the right manner. In general, if you sense a pulling-up feeling when you squeeze, you're using the right muscles. Men may feel their penises pull in slightly toward their bodies. To double-check that you're contracting the right muscles, try the exercises in front of a mirror. Your abdominal, buttock or leg muscles shouldn't tighten if you're isolating the muscles of the pelvic floor. Another way to be sure you're doing Kegels correctly is a simple finger test. Place a finger in your anus or vagina. Then squeeze around your finger. The muscles you contract are your pelvic floor muscles.

If you're still not sure whether you're contracting the right muscles, ask your doctor for help. Your doctor can refer you to a physical therapist for biofeedback techniques that will help you identify and contract the right muscles.

After several months of doing pelvic floor muscle exercises correctly, you should notice improvement in your urinary control. Contract your pelvic muscles to control leakage when you have an urge to urinate or when you cough or sneeze.

Bladder training. Your doctor may recommend bladder training — alone or in combination with other therapies — to control urge and other types of incontinence. Bladder training involves learning to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. Then try increasing the waiting period to 20 minutes. The goal is to lengthen the time between trips to the toilet until you're urinating every two to four hours.

Bladder training may also involve double voiding — urinating, then waiting a few minutes and trying again. This exercise can help you learn to empty your bladder more completely to avoid overflow incontinence. In addition, bladder training may involve learning to control urges to urinate. When you feel the urge to urinate, you're instructed to relax — breathe slowly and deeply — or to distract yourself with an activity.

Scheduled toilet trips. This means timed urination — going to the toilet according to the clock rather than waiting for the need to go. Following this technique, you go to the toilet on a routine, planned basis — usually every two to four hours.
Fluid and diet management. In some cases, you can simply modify your daily habits to regain control of your bladder. You may need to cut back on or avoid alcohol or caffeine, if either causes you incontinence. If acidic foods irritate your bladder, cutting back on such triggers may rid you of your problem. For some people, reducing liquid consumption before bedtime is all that's needed. Losing weight also may eliminate the problem.
Medications

Many times, urinary incontinence can be corrected with the help of medication. Often, medications are used in conjunction with behavioral techniques. Drugs commonly used to treat incontinence include:

Anticholinergic (antispasmodic) drugs. These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Examples include tolterodine (Detrol), oxybutynin (Ditropan), solifenacin (Vesicare) and darifenacin (Enablex). These drugs can be effective at controlling incontinence, but a side effect is dry mouth. To combat dry mouth, you may be tempted to drink more water. But that may not help your incontinence. Your doctor may recommend that you suck on a piece of candy or chew gum instead to produce more saliva. Or you may want to try an extended-release form of oxybutynin (Ditropan XL) or tolterodine (Detrol LA) or an oxybutynin skin patch (Oxytrol). These forms of medication may have fewer side effects than the standard forms do.
Imipramine (Tofranil). This antidepressant may occasionally be used in combination with other medications to treat incontinence. It causes the bladder muscle to relax, while causing the smooth muscles at the bladder neck to contract.
Antibiotics. If your incontinence is due to a urinary tract infection or an inflamed prostate gland (prostatitis), your doctor can successfully treat the problem with antibiotics.

Others. Your doctor may prescribe drugs that actually relax your urinary sphincter or make your bladder contract more, depending on the underlying cause of your incontinence. If you're a man with incontinence caused by an enlarged prostate gland, your doctor may prescribe medications or other therapies to treat your condition. The goal may be to relax muscles around your urethra so that you can urinate with more control or to shrink the size of your prostate. Rarely, a medication known as bethanechol (Urecholine) may be prescribed to improve a weakened bladder's muscle strength. But because bethanechol is associated with heart and blood vessel side effects, you shouldn't take it in high doses or without careful monitoring to make sure it is working — that is, improving the emptying of your bladder.

Electrical stimulation
In this procedure, electrodes are temporarily inserted into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but it takes several months and multiple treatments to work. And it can cause side effects, such as abdominal cramps, diarrhea and bleeding. Electrical stimulation is usually reserved for people with severe urge incontinence who don't respond to behavioral techniques or medications.

Medical devices
Several medical devices are available to help treat incontinence. They're designed specifically for women and include:

Urethral inserts. These are small, tampon-like disposable devices or plugs that a woman inserts into her urethra — the tube where urine exits the body — to prevent urine from leaking out. Urethral inserts aren't for everyday use. They work best for women who have predictable incontinence during certain activities, such as playing tennis. The device is inserted before the activity. Whenever the woman needs to urinate, she simply removes the device. Urethral inserts are available by prescription.

Pessary (PES-uh-re). Your doctor may prescribe a pessary — a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage. You need to regularly remove the device to clean it. You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.
Surgery

If other treatments aren't working, several surgical procedures have been developed to fix problems that cause urinary incontinence. In men, surgery may be necessary to remove the obstructive part of an enlarged prostate gland.

If your bladder or uterus has slipped out of position, a surgeon can put it back in place with a variety of techniques. Rarely, surgery to treat urinary incontinence may involve enlarging the bladder or correcting a birth defect. Or surgery may be needed to bolster weakened urinary sphincter muscles.

Some of the more common procedures include:

Artificial urinary sphincter. This small device is particularly helpful for men who have weakened urinary sphincters from treatment of prostate cancer or an enlarged prostate gland, and it's used rarely in women with stress incontinence. Shaped like a doughnut, the device is implanted around the neck of your bladder. The fluid-filled ring keeps your urinary sphincter shut tight until you're ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to be released. This surgery is the most effective procedure for male incontinence. Complications include malfunction of the device — which means the surgery will need to be repeated — and infection, but both are uncommon.

Bulking material injections. Some women and men with stress incontinence benefit from urethral injections of bulking agents. This procedure involves injecting bulking materials — which may be cow-derived collagen, carbon particle beads or synthetic sugars — into the tissue surrounding the urethra or the skin next to the urinary sphincter. The injection tightens the seal of the sphincter by bulking up the surrounding tissue. The procedure is done with minimal anesthesia and typically takes about two to three minutes. It usually needs to be repeated after several months, because the effect can be lost over time. There is a risk of rejection or infection.

Sacral nerve stimulator. This small device acts on nerves that control bladder and pelvic floor contractions. The device, which resembles a pacemaker, is implanted under the skin in your abdomen. A wire from the device is connected to a sacral nerve — an important nerve in bladder control that runs from your lower spinal cord to your bladder. Through the wire, the device emits electrical pulses that stimulate the nerve and help control the bladder. The pulse doesn't cause pain and provides relief from heavy leaking in many cases. Possible complications include infection, but the device can be removed.

Sling procedure. The most popular and common surgery for women with stress incontinence is the sling procedure. During this procedure, a surgeon removes a strip of abdominal tissue and places it under the urethra. Or the surgeon may use a strip of synthetic mesh material or a strip of tissue from a donor (xenograft) or cadaver. The strip acts like a hammock, compressing the urethra to prevent leaks that occur with the activities of daily living. Sling procedures improve or cure incontinence in most cases. There are varying techniques for the sling procedure, so talk with your doctor about what procedure is planned and why.
Bladder neck suspension. In this procedure, your surgeon makes a 3- to 5-inch incision in your lower abdomen. Through this incision, he or she places stitches (sutures) in the tissue near the bladder neck and secures the stitches to a ligament near your pubic bone (Burch procedure) or in the cartilage of the pubic bone itself (Marshall-Marchetti-Krantz, or MMK, procedure). This has the effect of bolstering your urethra and bladder neck so that they don't sag. The downside of this procedure is that it involves major abdominal surgery. It's done under general anesthesia and usually takes about an hour. Recovery takes about six weeks, and you'll likely need to use a catheter until you can urinate normally.

Absorbent pads and catheters
If medical treatments can't completely eliminate your incontinence — or you need help until a treatment starts to take effect — you can try products that help ease the discomfort and inconvenience of leaking urine. These products should be a last resort, because most people benefit from other treatments.

Pads and protective garments. Various absorbent pads are available to help you manage urine loss. Most products are no more bulky than normal underwear, and you can wear them easily under everyday clothing. Men who have problems with dribbles of urine can use a drip collector — a small pocket of absorbent padding that's worn over the penis and held in place by closefitting underwear. Men and women can wear panty liners or pads in their underwear to collect urine. Adult diapers are available in both disposable and reusable forms and come in a variety of sizes. Some people find that wearing plastic underwear over their regular underwear helps keep them dry. Others opt for washable underwear and briefs with waterproof panels. Incontinence products can be purchased at drugstores, supermarkets and medical supply stores.

Catheter. If you're incontinent because your bladder doesn't empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder (self-intermittent catheterization). This should give you more control of your leakage, especially if you have overflow incontinence. You'll be instructed on how to clean these catheters for safe re-use. In rare cases of extreme illness, people have to keep a catheter in constantly. The catheter is connected to an external bag to hold urine. As needed, the bag is emptied.