Treatments

Treatments for Urinary Incontinence

Treatment for urinary incontinence may vary depending on an individual woman’s symptoms, and goals for treatment. Your specific treatment will be determined after a thorough evaluation and discussion between you and your team of physicians and healthcare providers. We strive to provide individualized treatment plans to meet each women’s goals and expectations with the overarching aim to restore your quality of life.

Many of the treatments offered are nonsurgical and involve rehabilitation of the pelvic floor muscles and retraining your body and bladder to work. However, office based procedures as well as minimally invasive surgeries are often chosen by women to treat urinary incontinence. Sometimes, women will choose to pursue several treatment options to best alleviate their symptoms. Depending on the type of incontinence, treatments may include:

Stress Urinary Incontinence Treatment options

Most therapies for reducing symptoms related to stress urinary incontinence focus on compensating for the decreased function of the urethral sphincter and pelvic floor muscles.

Lifestyle Changes

Some lifestyle changes can help reduce symptoms of stress urinary incontinence, including:

  • Keeping your bladder empty by urinating every 2 to 3 hours
  • Maintaining normal weight or losing weight, if overweight
  • Quitting smoking: Use of tobacco doubles the risk for developing pelvic floor disorders
  • Treating constipation and avoiding straining with bowel movements

Pelvic Floor Physical Therapy

Physical therapy of the pelvic floor is aimed at rehabilitating the pelvic floor muscles to restore their normal function. For the best results, you should work with a specialized physical therapist who will help you learn the most effective techniques. Some women need to improve their pelvic floor muscle function with strengthening exercises while others need stretching and relaxing exercises. Your Urogynecologist will evaluate your pelvic floor muscles at your initial consultation and provide a referral if necessary.

Pessary Therapy

A pessary is a small silicone device that is inserted into the vagina to provide slight pressure on the urethra which helps to keep it closed. This will allow you to control leakage of urine and still be able to urinate normally. Pessaries are usually used temporarily to avoid surgery in women who have not completed their families or have medical problems that make surgery risky. Some patients wear a pessary only when they are performing activities which worsen leakage, such as exercise. Alternatively, some women choose to wear their pessary throughout the day. If you are interested in trying a pessary, one of the Urogynecologists at the Women’s Integrated Pelvic Health Program can find one that works for you.

Urethral Bulking Agents

Your Urogynecologist may also recommend injecting a substance to help “bulk up” your urethra. She will evaluate you to determine if you are a good candidate for this procedure. There are several different types of bulking agents. These can be administered 1 to 3 times a year as an injection in the office setting. Bulking agents allow you to be active immediately, but will wear off after several months. This is an attractive management option for women with stress incontinence that would like a procedural option, but are unable to tolerate a minimally invasive surgical procedure due to other medical problems.

Surgery

Surgery for urinary incontinence is intended to compensate for the weakened sphincter muscle and support around the urethra. Surgery is often low-risk and is usually very successful. Your Urogynecologist will discuss the surgical options then help you to select the treatment that best suits your specific goals. These procedures have a high cure rate, but, as with all procedures, there are also risks involved. Your Urogynecologist will help you weigh the risks and benefits of the different surgical procedures and help you decide on the best option for you.

Some of the procedures include:

  • Midurethral sling: Midurethral sling is the most commonly performed procedure for stress incontinence because of its high cure rates and quick recovery time. A synthetic mesh (permanent medical grade plastic material called polypropylene) is placed under the urethra through a tiny incision made in the anterior vaginal wall. The sling helps to lightly support/compress the urethra during times of increased abdominal pressure (ie laughing, running, jumping). This procedure has been extensively studied and continues to demonstrate high efficacy with few complications and side-effects. It has largely replaced more traditional surgical options for managing stress incontinence owing to it’s minimally invasive approach (small incision in the vagina), ability to be performed under sedative anesthesia, and quick recovery time.
  • Rectus fascial sling: Fascial slings are similar to midurethral slings; however, instead of using synthetic material to compress the urethra, your Urogynecologist uses your own tissue or fascia to compress the urethra. In addition to the vaginal incision, this procedure requires making a small incision on your abdomen (similar to a “bikini cut” incision). It takes longer to recover and has more risks, but may be the best option for some women, especially those who already had a midurethral sling.
  • Urethral suspension (Burch colposuspension): Burch colposuspension uses permanent stitches to support the urethra. It is typically done through an incision on your abdomen (similar to a “bikini cut” incision), but can be done using laparoscopy or robotics.

Urgency Urinary Incontinence/Overactive Bladder

Most therapies addressing urgency urinary incontinence focus on decreasing the abnormal contractions in the bladder, which lead to urinary leakage.

Lifestyle changes

Some lifestyle changes can help reduce symptoms of urgency urinary incontinence, including:

  • Keeping your bladder empty by urinating every 2 to 3 hours
  • Limiting fluids which worsen incontinence including alcohol, caffeinated beverages, and high sugar beverages

Pelvic Floor Physical Therapy

Physical therapy of the pelvic floor is aimed at rehabilitating the pelvic floor muscles to restore their normal function. For the best results, you should work with a specialized physical therapist who will help you learn the most effective techniques. Some women need to improve their pelvic floor muscle function with strengthening exercises while others need stretching and relaxing exercises. Your Urogynecologist will evaluate your pelvic floor muscles at your initial consultation and provide a referral if necessary.

Medications

There are a variety of medications that treat incontinence. These medications are especially useful for treating an overactive bladder associated with urgency urinary incontinence; however, many patients with mixed symptoms of urgency and stress incontinence will benefit from medical therapy.

Some medications that may help with urinary incontinence include:

  • Local vaginal estrogen: Low-dose topical application of estrogen to the vagina may help rejuvenate and tone tissues in the urethra, reducing some of the symptoms of urinary incontinence.
  • Anticholinergic oral medications: There are many different types of these medications that when taken daily help treat urgency incontinence or overactive bladder, such as: oxybutynin (Ditropan®), solifenacin (Vesicare®), fesoterodine (Toviaz®), tolterodine (Detrol®), darifenacin (Enablex®) and trospium (Sanctura®)
  • Beta agonists: Mirabegron (Myrbetrig®) is a daily medication that you take by mouth every day that relaxes the bladder muscle and decreases abnormal or unwanted contractions

Procedures

Sometimes, lifestyle changes and medications might not adequately manage a woman’s symptoms of incontinence. There are several minimally invasive procedures which are low risk and effective at treating refractory (non-responsive) urgency urinary incontinence.

  • Botox: Injections of onabotulinum toxin (Botox®) into the bladder muscle may reduce urinary leakage episodes in women with urgency incontinence or overactive bladder. This is a procedure performed in the office where onabotulinum toxin is injected directly into the bladder muscle through a small telescope placed in the urethra (cystoscopy). Onabotulinum toxin injections are very effective and take about 2 weeks to take effect. Since this medication is not permanent, injections may be needed every six to nine months.
  • Sacral Neuromodulation: This is a minimally invasive procedure performed in the office or under sedation in the operating room, in which a thin wire is connected to a neurostimulator (similar to a pacemaker) delivers small impulses to the nerves that control the bladder. The therapy targets the sacral nerves which travel from the spinal cord to pelvic muscles and organs, including the bladder. The first step of this procedure is a test phase which allows women to trial the therapy and determine whether their symptoms are adequately controlled. If women have success with the test phase, a permanent version is placed in the operating room.
  • Percutaneous Tibial Nerve Stimulation: Another way in which to regulate the nerves to the bladder is via percutaneous tibial nerve stimulation. This procedure is less permanent than sacral neuromodulation and ideal for women who want to avoid a procedure in the operating room. Percutaneous tibial nerve stimulation utilizes a tiny acupuncture needle placed in the skin over the ankle to deliver electrical pulses to the tibial nerve. The procedure is done in the office weekly for about three months. It is painless and does not have any risks or side effects.