Urinary Incontinence Treatment Options

Incontinence is not a life-threatening problem, but it can be a social problem, possibly leading to loss of self-esteem, depression, feelings of helplessness or even sexual problems. Thankfully, incontinence can be treated and, in most cases, corrected or improved so that it is no longer a health and social problem. Incontinence can be treated in one of three ways:

Medication

Numerous medications have been developed in the past 10 years to treat incontinence, and these developments have significantly improved the treatment process. Many of these medications can decrease and even eliminate the uncontrolled loss of urine in patients.

Medications used to treat overactive bladder work by relaxing the bladder muscle and making it less sensitive. These medications include Detrol, Ditropan, Urispas, Levsin, Bentyl and Tofranil. The most common medicine prescribed for stress incontinence is Estrogen, which is most effective in postmenopausal women. Medications for other types of incontinence include Flomax, Hytrin and even Botox.

Biofeedback

Special exercises and training programs can be helpful and effective in treating incontinence and improving bladder control. Certain exercises, known as Kegel exercises, strengthen the sphincter and pelvic floor. These exercises must be done correctly and consistently in order to be effective.

Gradually prolonging the time between visits to the toilet, known as bladder retraining, can also be effective when coupled with reasonable fluid intake. Eliminating foods and liquids such as caffeine, alcohol and spicy foods, which can irritate the bladder muscle, may decrease symptoms.

Surgery

Surgery is an option for patients who have not been helped by biofeedback and/or medication or who are not candidates for those treatments. Surgery can be approached in one of three ways: through the lower abdomen, through the vagina or by injecting a liquid "bulking agent" around the urethra.

Surgery through incision in the lower abdomen is effective for correcting stress incontinence. However, the recovery time can be quite long, requiring six to eight weeks of limited activity following the procedure. In the past 10 years, this procedure has been performed more and more using a laparoscope, which lessens the recovery time.

Surgery approached through the vagina, or "sling surgery," is performed by making a vaginal incision and placing a strip of tissue, or "sling," either above or beside the urethra. This sling provides support for the urethra and sphincter muscles and adds compression to the urethra. This sling surgery can be performed on an outpatient basis with less recovery time. It is currently the most frequently performed surgery for stress incontinence.

Both surgery through the abdomen and through the vagina have excellent results, with 85 percent of patients being dry at five to 10 years.

Surgery using "bulking agents" does not require an incision. A thick liquid compound is injected around the urethra to compress and close the urethral channel. The advantage of this procedure is that there is only a 24-hour period of limited activity required following the surgery. However, the disadvantage is that the effects generally last for only one month to one year.

Another type of surgical procedure called sacral nerve stimulation with Interstim is also an option for incontinence patients. This is a minimally invasive procedure in which a neurostimulator is implanted over the hip and used to reprogram the nerves that control the bladder. This procedure has been shown to correct or significantly improve urge incontinence in 70 percent to 80 percent of patients who have failed other treatments.