Urinary incontinence treatments at a glance
- Treatments for urinary incontinence depend on the type of incontinence, such as stress incontinence and overactive bladder, and range from lifestyle changes to surgery.
- When appropriate, treatment plans start with the least invasive method, which in many cases can include behavioral change by the patients.
- The Urology Care Foundation says a quarter to a third of men and women in the United States have urinary incontinence, and treatment options are similar for both sexes.
What treatments options are available for urinary incontinence?
Treatment options for urinary incontinence depend on the type of urinary incontinence being diagnosed. These include stress urinary incontinence, overactive bladder, urge incontinence and mixed incontinence. Most treatment plans will begin with the least invasive options and focus on nonmedical behavioral changes.
If these do not work or if the initial diagnosis calls for more aggressive treatment, other therapies including medications or surgery may be used. While typically thought of as an ailment that affects more women, men also have urinary incontinence, though the prevalence of it in men is lower than in women for all age groups. Many of the treatment options for men are similar to the treatment options for women.
Specific treatments for stress urinary incontinence
- Behavioral therapy and pelvic floor training (+/- biofeedback).
- Occasionally a provider will prescribe medications to tighten the urethral sphincter.
- Bulking injections add synthetic matter to tissues around the urethra to help support it and reduce urinary leakage.
- If pelvic organ prolapse is noted, the doctor may recommend using a pessary, which is a ring that a woman inserts into the vagina to hold up the bladder and prevent leakage.
- Surgical options (detailed information below).
Specific treatments for urge urinary incontinence
- Behavioral therapy (details below).
- Medications. Common medications prescribed to treat urge urinary incontinence might include:
- Anticholinergics to help with overactive bladder/frequent urination.
- Alpha blockers relax the bladder and prostate muscles in men experiencing overflow or urge incontinence.
- Topical estrogen cream for women can reduce some symptoms.
- Nerve stimulation. A pacemaker-like device can be inserted under the skin to stimulate nerves that control the bladder.
- Botox. Botox injections, in addition to treating urge incontinence, may also be used for people who have an overactive bladder.
Behavioral changes as effective incontinence treatments
Patients are encouraged to make several changes to their daily routine that will likely improve their incontinence symptoms including the following.
- Re-training their bladder by waiting to go to the bathroom for about 10 minutes after the urge presents. The patient then slowly increases the amount of time delay before urination, with the goal of urinating every 2-4 hours.
- Double voiding, which is urinating, waiting a minute or so, then trying to empty the bladder once more. This helps to more completely empty the bladder.
- Scheduling urination for preset times rather than waiting for the urge.
- Exercising pelvic floor muscles with Kegel exercises to strengthen muscles that control urination.
- Exercise and healthy eating, patients should try to maintain a healthy weight, exercise, drink fewer fluids, and restrict the intake of alcohol, caffeine and acidic foods.
InterStim Therapy can be used for both male and female patients. InterStim uses an implanted device that sends electrical pulses to the sacral nerves, located in the lower area of the spinal cord. InterStim Therapy, also known as sacral nerve stimulation or sacral neuromodulation, is not intended for patients with stress incontinence. InterStim Therapy is used at Urology Associates to treat urinary incontinence and other conditions.
Treating urinary incontinence with injections
Injections can treat urinary incontinence in both men and women.
Injections for women
Surgeons use two types of injections to treat urinary incontinence in women.
Botox (botulinum A toxin) is used to calm the nerves, helping to block the signals that trigger urinary incontinence. Botox, while popularly recognized for its use in cosmetic procedures, can treat a range of medical ailments, including urinary incontinence and over active bladder. Botox injections last up to six months, with patients needing additional injections when the previous injections wear off.
Injections of bulking agents are also used to treat urinary incontinence. This procedure uses collagen or other synthetic material to provide support to the urethra. The surgeon will place a small scope into the patient’s urethra, accessed through the vagina, then pass a needle through the scope, guiding it near to where the urethra meets the opening of the bladder. The surgeon then injects the bulking agent, which will solidify and help close off the urethra.
Similar to the Botox injections, patients may need additional injections to maintain the treatment’s effects. Female patients of childbearing age may prefer injection treatments over the sling procedure (see below) due to the unknown effect that birth will have on the sling’s placement.
Injections for men
Similar to the injection treatments offered to women, men can be treated with both Botox or bulking agents. Botox injections can especially help men who have an enlarged prostate, which can cause problems in the bladder and urination difficulties. The main difference between bulking agent injections for men and women is how the needle enters the urethra. For a man the doctor guides the needle through his skin directly into the urethra.
Surgery for urinary incontinence
When less invasive treatments for incontinence fail to provide results, surgery may be an option for some patients. There are several surgical treatment options available for both men and women.
Sling procedure for women
The most common type of surgery to correct stress incontinence is a sling procedure. During this procedure, surgeons use body tissue, mesh or synthetic materials to create a sling or ribbon that acts as a hammock to support the urethra. The sling ensures the urethra remains closed during nonurinating actions like laughing, coughing, sneezing or lifting.
There are a few different types of sling procedures. The most common is a midurethral sling surgery. During a midurethral sling procedure, a surgeon will use a narrow piece of synthetic mesh placed under the urethra to support it and the neck of the bladder. There are three types of midurethral sling placements:
- The retropubic method, which is also referred to as “tension-free vaginal tape” (TVT).
- Transobturator, which is sometimes called “transobturator tape” (TOT).
- A single incision sling procedure, which is often referred to as a mini-sling.
During a TVT procedure the surgeon will make a small cut inside the patient’s vagina under her urethra and two smaller cuts above the pubic bone. These incisions are tiny, only big enough to fit a needle through. The surgeon then uses the needle to place the sling under the patient’s urethra, behind the pubic bone, using skin glue or stitches to close the cuts.
Similar to a TVT procedure, during a TOT procedure a surgeon will make small cuts inside a patient’s vagina and under her urethra. The TOT procedure cuts are made on each side of a patient’s labia and the sling is then placed under the urethra.
During the single incision sling procedure, which is often referred to as a mini-sling, the surgeon uses a shorter piece of surgical mesh and will make only one incision. There is no need for stitches to hold the sling in place, and over time scar tissue develops around the sling to stabilize it.
In addition to midurethral slings, another surgical treatment option is a traditional sling. A traditional sling procedure is more invasive than the midurethral sling surgeries. The surgeon will use tissue from either the stomach or thigh to create the sling. The tissue used to create the sling either is from the patient or a donor.
The surgeon will make an incision in the abdominal wall and then stitch the sling into place. Patients who opt for a traditional sling may need to stay in the hospital overnight. Traditional sling surgeries have a longer recovery time than the midurethral slings.
Before the sling procedures gained popularity, surgeons relied on urethropexies to surgically treat urinary incontinence. Surgeons use several types of urethropexies to stabilize the bladder neck and urethra.
The original type of urethropexy was a Marshall-Marchetti-Krantz (MMK) procedure, also referred to as a bladder neck suspension or a retropubic suspension. During an MMK procedure, the patient is under general anesthesia when the surgeon makes a long cut along her abdomen, exposing the bladder. The surgeon separates the bladder from the surrounding tissue and then uses stitches near the bladder neck and urethra to stabilize the bladder and urethra. The urethra is then lifted, and additional stitches are used to attach the urethra to the public bone.
A Burch colposuspension, also called a Burch urethropexy or colposuspension, has grown in popularity among surgeons after concerns arose in the surgical community regarding bone complications with the MMK procedure. Many surgeons now use the Burch colposuspension as the primary urethropexy.
There are many versions of this surgery, and the two most common are detailed above. A surgeon can perform a Burch procedure during an open surgery, where the surgeon makes a long cut along the bikini line, through the vagina. Or the surgery can be performed laparoscopically (less invasive). While sling procedures are now considered the gold standard in treating urinary incontinence in women, a laparoscopic Burch is an alternative for those who wish to avoid procedures that use synthetic mesh.
Sling procedure for men
Similar to the sling procedure for women, in the male surgical option the surgeon makes small cuts between his scrotum and anus. The sling is then placed under the urethral bulb. The placement of the sling lifts and squeezes the urethra. The male sling procedure was developed for men with urinary incontinence due to a radical prostatectomy (prostate removal) or sphincter weakness.
Artificial urinary sphincter for men
For extensive urinary incontinence in male patients, an artificial urinary sphincter may be recommended. This is a small ring filled with fluid that is surgically placed around the bladder. When the patient would like to empty his bladder, he presses a valve placed under the skin that will cause the ring to deflate and allow urine to flow from the bladder.
While this is a different procedure than prostate removal due to prostate cancer, if a male patient’s enlarged prostate is causing urinary incontinence, his doctor may recommend having the prostate surgically removed.