Urinary Incontinence: Treatment

Bladder Problems Find out the different types, and ways to overcome this common problem.

More about Urinary Incontinence: Definition Causes and symptoms Diagnosis Treatment Prognosis Prevention Resources

There are numerous invasive and noninvasive treatment options for urinary incontinence:

• Bladder training. Used to treat urge incontinence, bladder training involves placing a patient on a toileting schedule. The time interval between urination is then gradually increased until an acceptable time period between bathroom breaks is consistently achieved.
• Biofeedback. The use of sensors to monitor temperature and muscle contractions in the vagina to help incontinent patients learn to control their pelvic muscles.
• Collagen injections. Collagen injected in the tissue surrounding the urethra can provide urethral support for women suffering from stress incontinence.
• Inflatable urethral insert. Sold under the tradename Reliance, this disposable incontinence balloon for women is inserted into the urethra and inflated to prevent urine leakage.
• Intermittent urinary catheterization. The periodic insertion of a catheter into a patient's bladder to drain urine from the bladder into an attached bag or container.
• Medication. Estrogen hormone replacement therapy can help improve pelvic muscle tone in postmenopausal women. Anticholinergics (i.e., propantheline, or Pro-Banthine) and antispasmodics (i.e., oxybutynin, or Ditropan) are sometimes prescribed to relax the bladder muscles. Other over-the-counter medications such as pseudoephedrine (i.e., Actifed, Benadryl, Dimetapp) and phenylpropanolamine (i.e., Dexatrim, Acutrim) may be prescribed to tighten the urethral sphincter.
• Pelvic toning exercises. Exercises to tone the pelvic muscle can help alleviate stress incontinence in both men and women. These exercises involve tightening the muscles of the pelvic floor, and are also known as Kegel or PC muscle exercises.
• Perineal stimulation. Perineal stimulation is used to treat stress incontinence. The treatment uses a probe to deliver a painless electrical current to the perineal area muscles. The current tones the muscle by contracting it.
• Permanent catheterization. A permanent, or indwelling, catheter may be prescribed for chronic incontinence that doesn't respond to other treatments. A Foley catheter is usually used for urinary catheterization. One end is inserted through the urethra and into the bladder, and the external end is attached to a plastic reservoir bag that the patient may wear on the leg. A second alternative is a permanent catheter, called a suprapubic tube, surgically inserted into the bladder. The tube exits the body through the abdomen near the pubic bone, where it is attached to a drainage bag. As infection may result, this treatment should be reevaluated periodically, and the possibility of alternative treatment addressed.
• Surgery. Bladder neck suspension surgery is used to correct female urinary stress incontinence. Surgical techniques such as the Marshall-Marchetti-Krantz and Burch procedures use sutures to raise and support the bladder neck and urethra. A sling procedure, which uses a strip of biocompatible material or the patient's own muscle or tissue as a supportive sling under the urethra and bladder neck, may also be used to treat stress incontinence. Bladder enlargement surgery may be recommended to treat incontinent men and women with unusually small bladders.
• Urinary sphincter implant. An artificial urinary sphincter may be used to treat incontinence in men and women with urinary sphincter impairment.
• Vaginal inserts. Devices constructed of silicone or other pliable materials that can be inserted into a woman's vagina to support the urethra.

— Paula Anne Ford-Martin