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Treatment Overview
The best treatment depends on the cause of your incontinence and your own preferences.
Home Treatment
If you experience long-term incontinence, you can take some steps immediately that may eliminate or reduce the problem.
Medications
Urinary incontinence may be treated with medications, but Kegel exercises and behavioral methods are often tried first.
Surgery
There are several kinds of surgeries to treat stress incontinence.
Other Treatment
Exercise and changes in habits are often successful in treating mild to moderate incontinence
Surgery
There are several different kinds of surgeries to correct stressurinary incontinence, which results when weakened pelvic floor muscles allow the bladder neck and urethra to drop. These surgeries seek to lift the urethra and/or bladder into their normal position. When they are returned to their proper position, sneezing, coughing, and laughing are less likely to result in the release of urine from the bladder.
Surgery is usually not done for urge incontinence.
The decision to have surgery must always be based on an accurate diagnosis, consideration of other treatment possibilities, and realistic expectations for the surgery.
Surgery Choices
- Tension-free vaginal tape (TVT) surgery. TVT surgery is becoming more popular among women with stress incontinence. During this surgery, a meshlike tape is positioned under the urethra like a sling or a hammock to support it and return it to its normal position. The surgeon inserts the tape through small incisions in your vagina and pubic hair line. TVT surgery takes approximately 30 minutes and is usually done under local anesthesia. This surgery can also be done to correct incontinence that has recurred after having another type of incontinence surgery.
- Retropubic suspension. The Marshall-Marchetti-Krantz (MMK) and Burch colposuspension procedures are the most common types of retropubic suspension. Retropubic surgeries provide lift to the sagging bladder neck and urethra by attaching their supporting tissues to the pubic bone or tough ligaments. These surgeries require hospitalization.
- Urethral sling. The surgeon fashions a piece of muscle, ligament, or tendon tissue or synthetic material into a sling that lifts the urethra back into a normal position. Since this involves abdominal surgery, hospitalization is required.
Other Treatment
Changes in habits (behavioral methods) and exercise are often used first to treat urinary incontinence because they do not involve surgery, have no serious side effects, can be done at home, and do not limit future treatment options. These methods are often successful in treating mild to moderate incontinence.
- Behavioral methods. These methods, which include bladder training and timed voiding, are used to treat urge incontinence.
- Exercise. Pelvic floor, or Kegel, exercises strengthen the pelvic muscles involved in urination and are used to treat stress or urge incontinence.
- Electrical stimulation. Electrical stimulation treatment uses a mild electrical current to stimulate the pelvic muscles that are involved in urination. Although not well studied, this method seems to be more effective for urge incontinence than for stress incontinence.
- Mechanical devices. These devices include a pessary (a rubber device that is inserted into the upper vagina to lift the bladder to help control stress incontinence) and a catheter (a thin, flexible tube that a woman inserts into her bladder to drain urine and help control overflow incontinence).
- Absorbent products. These include adult diapers, plastic-coated underwear, pads, or panty liners that attach to underwear.
- Urethral bulking. Urethral bulking involves injecting collagen or other bulking materials around the urethra to build up the urethra where it leaves the bladder. This procedure usually relieves symptoms for about 1 year, although 2 to 3 injections are likely to be needed.
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