Urinary incontinence is a loss of bladder control that often causes urine to leak out of the body. The condition may be temporary due to a reversible medical condition (constipation or infection), or it may be chronic, resulting from aging or changes to the urinary or neurological systems. Treatment for incontinence includes three general approaches: medication, behavioral modification and surgery. The treatment recommended by a physician will depend on the underlying cause of incontinence and the severity of the symptoms.
Medications for the Treatment of Incontinence
Medications prescribed for the treatment of incontinence target the muscles of the bladder and help reduce involuntary leakage. Examples include:
- Anticholinergic Medications: Trospium (Sanctura), solifenacin (Vesicare), darifenacin (Enablex) and oxybutynin (Oxytrol, Ditrpoan) are anticholingeric medications that can be taken to relax bladder muscles that cause sudden urges to urinate. These medications are the most commonly prescribed and are generally well tolerated. However, there are some side effects such as dry mouth, constipation, dizziness, sleepiness and changes in vision.
- Topical Estrogens: Ogen, Premarin, Estrace and Estrig are topical estrogens that can be given to women experiencing incontinence. Estrogen is a hormone that maintains breast, ovary and vaginal function in women of child-bearing age. During menopause, estrogen levels in the body begin to decline, weakening the vaginal walls and causing the bladder to drop. Estrogen can strengthen the vaginal wall and reduce leakage in women that develop stress incontinence. Although this method can be effective, it poses a greater risk of breast and uterine cancer, gall bladder disease and high blood pressure.
- Botulinum Toxin Injections (Botox): Botulinum toxin can be injected directly into the bladder muscles to relax them and stop urge incontinence. These injections can be provided on an outpatient basis. Pain, irritation and infection are potential side effects.
Behavioral Modification for the Treatment of Incontinence
Behavior modifications refer to lifestyle changes and exercises that may be used in conjunction with medication to reduce or eliminate symptoms of incontinence. They can include:
- Dietary Changes: The doctor may recommend that patients with incontinence eliminate foods and liquids from their diet that irritate the bladder. Caffeinated beverages, alcohol and citrus are irritants that increase incontinence symptoms.
- Using Sanitary Pads or Disposable Underwear: Sanitary pads or absorbent underwear can be used to prevent urine leakage onto the clothes and skin. These devices may be helpful for controlling incontinence if other interventions are not effective.
- Bladder Retraining: Bladder retraining requires the patient to identify when incontinence occurs. For instance, if incontinence occurs two hours after urinating, retraining would require the patient to urinate before incontinence occurs (e.g., after 1.5 hours). Retraining helps reduce incontinence with the goal of increasing the time between trips to the bathroom.
- Kegel Exercises: Kegel exercises can be done by men and women to strengthen the sphincter muscle that controls the bladder. These exercises require the patient to tighten the muscles that are used when holding in urine by constricting them for 10 seconds. The exercises should be repeated several times a day, each day.
Surgical Treatments for Incontinence
Currently there are several different surgical options for incontinence. However, these treatments are often only recommended if medication and behavioral modifications have not been effective. Different procedures are used for women and men.
The most common surgical treatments for incontinence in women are:
- Retropubic Suspension: If the bladder falls out of place due to a weakening of the vaginal wall, this procedure can be used to situate the bladder back in the correct position. One or more incisions are made in the lower part of the abdomen. Surgical instruments are inserted through the cut(s), allowing for the bladder, part of the vaginal wall, and the urethra to be sutured to the pelvic bones and ligaments. This raises the urethra and the bladder.
- Pubovaingal Fascial Sling: In this procedure, a material known as fascia is placed around the neck of the bladder to stop urine from involuntarily leaking.
- Suburethral Sling: This procedure involves placing a sling under the urethra to support the neck of the bladder and prevent leakage.
- Tension-Free Vaginal Tape (TVT): TVT is a mesh that is placed around the neck of the urethra to provide additional support and stop urine from leaking.
The most common surgical treatments for incontinence in men are:
- Male Sling: The male sling involves placing a strip of material underneath the urethra to stop the urethra from opening involuntarily.
- Artificial Sphincter: The artificial sphincter is typically recommended for men that have had prostate surgery and experience nerve damage. This procedure requires the placement of a soft cuff around the urethra that can be controlled manually through a pump outside of the body. Squeezing the pump allows urine to flow through the urethra and out of the body.
- Bulking Injections: Bulking injections require the doctor to inject collagen or other natural materials into the tissue surrounding the urethra. This material makes the urethra more resistant to leakage, which reduces or eliminates incontinence.
Prognosis Following Incontinence Treatments
Prognosis following treatment will vary based on the type of incontinence, the severity of the condition and the remedies used. Incontinence typically worsens with age. As such, ongoing treatment may be needed to control symptoms.
References
Age Page: Urinary incontinence. (2013). National Kidney and Urologic Diseases Information Clearinghouse.
Riley, J. (2012). Urinary incontinence. Conditions & Procedures, 1-3.
Urinary incontinence. (2011). National Library of Medicine.
