There are many options available for urinary incontinence treatments depending on the type of urinary incontinence, the severity and frequency of urinary leaks, the patient’s lifestyle, activity level and personal preferences. To determine the treatment options available for a patient, the physician completes a thorough physical examination, enquires about the patient’s medical history and assesses the patients current drug intake. The treatment options include a range of noninvasive measures, interventional therapies, devices and invasive surgical treatment. For most incontinence patients, combining two or more methods of treatment usually works best to reduce or completely eliminate urinary leakage.
Non invasive measures are almost always the first lines of treatment, either alone or coupled with other treatment options. The initial treatment steps include some behavioural modification techniques aimed at attacking the lifestyle factors, which precipitate or worsen urinary incontinence. Such lifestyle modifications include losing weight, reducing intake of caffeinated beverages and going to the toilet by the clock rather than waiting for the urge to urinate. Physicians may also deem it necessary to change prescription drugs known to increase urine volume (called diuretics), or drugs known to weaken voluntary control over urine such as sedatives and drugs that cause muscle relaxation.
The most common, and by far the most useful, non invasive measure prescribed to most incontinence patients is physical therapy to strengthen the muscles controlling the flow of urine. These muscles are known as the pelvic floor muscles. Pelvic floor muscles can be strengthened through regular exercises, known as Kegel exercises, or through electrical stimulation using small electrodes inserted through the vagina or rectum. Pelvic floor muscle strengthening usually benefits urge and stress incontinence greatly. However, the results are not immediately observed. It is a long-term commitment which may take many months before any improvement is felt. This makes most patients quit. And although it is a very effective and safe approach, the poor patient compliance makes it necessary in most instances to add another back up measure, such as medications to help tighten the bladder neck muscles or prevent unintended bladder contraction.
If medications and the above simple measures are not enough, doctors may opt for the use of medical devices or interventional therapies. Most medical devices, like the pessary and the bladder neck support device, are designed with the female in mind. They function by holding up the bladder to prevent leakage. Devices that seal the urethra to prevent urine escaping are also sometimes used.
Interventional therapies are aimed at causing contraction or spasm of the muscle which allows urine to escape from the bladder into the urethra. These therapies include botulinum toxin injection and an implantable device known as the sacral nerve stimulator.
When all else fails, a doctor may opt for surgery for urinary incontinence treatments. There are many procedures available but the most commonly preformed are sling procedures in which a surgeon places a sling around the junction between the bladder and the urethra to keep it closed unless the patient voluntarily urinates.
It is important to remember that surgery is a last resort. Given enough time and dedication, most incontinence treatments significantly improve the symptoms and severity of urinary incontinence, and quite often they cure it completely.