Urinary incontinence happens when pee leaks from your bladder in between bathroom trips. A number of treatments are available. Yours will depend on what’s causing the problem and how serious it is.
Your doctor might ask you to make simple lifestyle changes, or take medicine, or get surgery. They’ll first want to try the things that have the least impact on your body.
Behavioral Changes
Switching up your habits -- doctors call these behavioral changes -- can help the two main types of incontinence:
- Stress incontinence happens when movements like sneezing or lifting put pressure on your bladder.
- Urge incontinence, a symptom of overactive bladder, is having a sudden need to go that you can’t control.
Sometimes, making small tweaks to your daily habits can help control urinary incontinence:
- Bladder training. This means controlling when and how often you use the bathroom. First, you’ll keep a diary around the clock to jot down details about your habits, including what you drink and how you feel before leaks happen. This will help your doctor make a schedule for you. When you go longer in between bathroom visits, your bladder will stretch and can hold more.
- Pelvic floor exercises. You might have heard of Kegels. This is a simple way to strengthen your pelvic floor, which can become weak after childbearing or because of aging. You’ll tighten, then relax your muscles, and repeat. This helps control your urine flow.
- Quit smoking. It makes you cough – which makes it hard to hold urine in. When you do it a lot, the muscles in your bladder can get more irritated. Smoking also is a main cause of bladder cancer.
- Urgency suppression. This is a way to control the sudden feelings of needing to go. It’s another type of bladder training. It can include a mix of distracting your mind, deep breathing, and Kegels.
Your doctor also might suggest that you limit how much you drink during the day, and possibly avoid caffeine and alcohol. Losing weight might help, too.
Medical Devices
These inserts for the urethra – the tube where urine travels from the bladder -- can help with stress incontinence:
- Urethral insert. Somewhat like a tampon, this disposable device can serve as a barrier to leaks during special activities.
- vagin*l pessary. If your bladder has prolapsed (dropped), this ring-like device can act as support. It’ll be inserted and fitted in the doctor’s office. It’ll need to be removed and cleaned, and can help avoid surgery.
Other devices that work to control the bladder remotely:
- eCoin Peripheral Neurostimulator System. This device delivers electrical pulses to help stimulate nerves that control the bladder. It is used for people with urgency urinary incontinence. It is implanted under the skin near the ankle and is controlled with a remote control.
- Percutaneous tibial nerve stimulation (PTNS). The doctor inserts a tiny needle attached to an electrode into the skin by your inner ankle. The electrode sends a pulse to the nerves at the base of your spine that control your bladder. Over time, the nerve stimulation eases your need to pee.
- Sacral nerve stimulation. This procedure is performed under sedation, not general anesthesia. Your doctor will implant a stimulator -- sort of like a pacemaker -- under your skin in your lower back, where your sacral nerve is located. These painless electrical impulses block messages from your bladder to your brain that you need to go. They can also strengthen your pelvic muscles and increase blood flow to your bladder. And, they release pain-blocking agents.
Bulking Agents
Fillers such as carbon beads and collagen help by plumping up the tissues where urine is released from your bladder, and help hold it in. This treatment is only used for stress incontinence. It can be done by injection in your doctor’s office. The fillers can go away with time, so you might need to have it done again.
Bulkamid is a hydrogel bulking agent that is injected into the wall of the urethra. This treatment is minimally invasive and long-lasting.
Medication
Estrogen replacement therapy, in the form of cream or a vagin*l ring, helps swell the area around your urethra and guard against leaking. It can help both types of urinary incontinence.
Drugs like pseudoephedrine are sometimes used to help tone up the urethra, and can help stress incontinence.
There are many drugs used for urge incontinence. Most work to relax the bladder and calm spasms that can cause the sudden need to pee. It might take some trial and error to find the right one.
Botox might also help relax the bladder. It’s sometimes used to treat patients with neurological conditions like spinal cord injuries or multiple sclerosis.
Surgery
If other methods for helping stress incontinence don’t work, your doctor might recommend surgery. These operations have very high success rates.
- Sling procedure. This is the most common. Your doctor will fashion a “hammock” using mesh and tissue to support your urethra. It can be done as outpatient surgery using local anesthesia. This means you will be awake during the procedure and go home the same day.
- Retropubic colposuspension. Your doctor might choose this method, along with a combo of others, if your bladder has dropped -- your doctor might use the term “prolapsed.” They’ll use stitches (sutures) to lift up and support tissues at the entrance to your bladder.
Electrical Nerve Stimulation
Electrical pulses can be used to stimulate your bladder and change the way it reacts. This helps control the urge to pee. These procedures are not performed for stress incontinence.
- Tibial nerve stimulation. This procedure does not require anesthesia and is an office procedure. A stimulator triggers your tibial nerve, which is located at your ankle. This sends electrical stimulation to your spine, where it affects the nerves that control your bladder.
Extra Measures
Medical treatments can help get your condition under control. But sometimes you might need some extra protection to boost your confidence and comfort. These might include:
- Catheter. If your bladder doesn’t fully empty after you pee, your doctor can show you how to use a catheter. It’s a thin, soft tube you insert into your urethra. You can insert it yourself, keep it clean, and use it throughout the day as needed.
- Pads. Adult absorbent pads and panties have become very streamlined and discreet. You can find them almost anywhere and wear them anytime.
