Millions of women have urinary incontinence, or involuntary loss of urine. According to the National Institute of Diabetes and Digestive and Kidney Diseases, compared to men, women have double the likelihood of urinary incontinence, and women become more vulnerable with age. The best treatment depends on the type of incontinence.
Behavioral Training
Timed voiding--using the bathroom on a regular scheduled basis--can help some women with incontinence. Bladder training involves waiting a few minutes before urinating after feeling the urge to go, and then gradually lengthening the interval between the urge and using the toilet. The Mayo Clinic recommends double voiding--emptying the bladder, waiting a few minutes, and then urinating again--for overflow incontinence, which occurs when urine leaks because the bladder is too full. Kegel exercises strengthen the pelvic muscles that retain urine and can improve bladder control after a few weeks, says the NIDDK.
Medication
According to the Merck manual, anti-cholinergic and anti-muscarinic drugs like oxybutynin, solifenacin and tolteridine relax the detrusor muscle that squeezes the bladder, effectively treating urge incontincence, which is the loss of urine after a sudden need to urinate. Oxybutynin comes as a pill or as a skin patch. For stress incontinence--loss of urine due to pressure on the bladder from coughing, sneezing or exercise--drugs like pseudoephedrine, imipramine and duloxetine can help.
Surgery
If behavioral measures and drugs do not work, surgery can effectively treat stress incontinence. A procedure called retropubic suspension supports the urethral sphincter, which closes off the bladder, by using surgical threads to hold it to ligaments in the pelvis. Sling procedures cradle the neck of the bladder to ease pressure on the urethra. An NIDDK study found that two years after surgery, about half of women who had a sling procedure and two-thirds of women who had a suspension procedure were free of stress incontinence.
Neuromodulation
Neuromodulation involves stimulating the nerves that control the bladder, and it can be an effective treatment for some women with urge incontinence who do not respond to behavioral treatments or drugs. The neuromodulation device must be surgically implanted.
Pessary
A vaginal device called a pessary can be helpful in cases of stress incontinence. Once inserted by a doctor, this stiff ring presses on the vaginal wall to hold the urethra in the correct position. The NIDDK warns that pessaries increase the risk of vaginal and urinary tract infections.
Bulking Agents
For stress incontinence, your doctor might recommend injecting bulking agents into the areas surrounding the neck of the bladder and the urethra to narrow the bladder opening. Collagen or carbon spheres can be injected under local anesthesia in as little as half an hour, says the NIDDK. Although this procedure is effective, you might need repeated injections.
