Both surgical and nonsurgical treatments can help with stress and urge incontinence.
Urinary incontinence is a common concern. The prevalence of any type of urinary incontinence is 25% to 45% worldwide. Even though it’s a common issue, that does not mean you must continue to endure this frustrating problem. Incontinence treatment options can help alleviate or reduce symptoms. Treatments fall into two categories: nonsurgical or conservative, and surgical. Choices will depend on the type of incontinence you’re experiencing — stress, urge or mix of both types — and on personal preference.
“This is a quality-of-life issue,” said Amy Hull, a nurse practitioner with Vanderbilt Women’s Health. “And because it’s a quality-of-life issue, people have choices or decisions to make based on how they want to pursue their treatment.”
Conservative, nonsurgical incontinence treatment options
Urge incontinence, which is leakage in response to the need to go, may be alleviated by certain behavioral modifications.
“Irritants may include caffeinated beverages, alcoholic beverages and beverages with a lot of sweeteners.”
“These techniques take time and a lot of effort on the patient’s part, but a motivated patient can achieve some really good results,” Hull said.
One behavioral modification includes fluid management.
“If a person is taking in too much fluid volume, they may want to modify that for a more moderate daily intake,” Hull said.
Eliminating bladder irritants from the diet can also help.
“Irritants may include caffeinated beverages, alcoholic beverages and beverages with a lot of sweeteners,” Hull said. “So, I often recommend to patients a reduction of the daily intake of coffee, sodas and teas.”
“If they feel like they have to go all the time, they may want to practice some techniques, such as urge suppression or time voiding to try to help retrain the bladder, so it’ll be a little bit less urgent.”
Another treatment option involves modifying your urination schedule or “voiding” schedule to use the restroom at regular intervals.
“If they feel like they have to go all the time, they may want to practice some techniques, such as urge suppression or time voiding to try to help retrain the bladder, so it’ll be a little bit less urgent,” Hull said.
If you experience both urge and stress incontinence, physical therapy may help. A physical therapist who specializes in the pelvic floor can teach you how to do Kegel exercises and specific suppressive techniques using your Kegels to help control leakage when you cough or sneeze or when you feel an urgent need to urinate.
A continence pessary may also be helpful for stress incontinence and can be used daily or episodically, such as during exercise when leakage may be most bothersome. Hull said she often fits people for these devices in the office.
“We have medications from two specific classes of drugs that can help reduce urgency and frequency.”
Medications can be a good option for those who have urge incontinence or mixed incontinence that is urge predominant.
“We have medications from two specific classes of drugs that can help reduce urgency and frequency,” Hull said. “Anticholinergic or antimuscarinic medications act on certain receptors in the bladder to help calm the bladder down a bit.”
Beta-3 agonist medications work on a different receptor to achieve the same result and may have fewer bothersome side effects, she added.
Surgical incontinence treatment options
For stress incontinence, many of Hull’s patients see the surgeon to undergo a urethral sling procedure to prevent leaks.
“We have two types of slings, which serve as almost a hammock or a backboard for the urethra,” Hull said.
Sling procedures are performed as day surgery, meaning you go home the same day.
“Patients need to be evaluated beforehand with specific testing called urodynamics to ensure that it’s the right treatment for their symptoms,” Hull said.
“Patients need to be evaluated beforehand with specific testing called urodynamics to ensure that it’s the right treatment for their symptoms.”
Severe stress incontinence is called intrinsic sphincter deficiency, or ISD. One treatment involves bulking injections for the urethra to help improve closure. A physical exam and urodynamics will help the clinician determine if the bulking injection is an appropriate treatment.
If behavioral modifications, physical therapy and medications do not improve urge incontinence, some procedures may help. One procedure is bladder Botox injections.
“Your surgeon goes in with a camera through the urethra and into the bladder, and then they inject Botox into the bladder muscle,” Hull said.
This procedure relaxes the muscle enough to help ease symptoms while still allowing the bladder to properly function. Botox injections are then repeated about six months later when the effect wears off.
Another surgical option for urge incontinence is called sacral neuromodulation. This procedure involves the placement of a sacral neuromodulation device that works at the nerve level to help calm the bladder.
“First, patients undergo a trial phase, and then if it is effective, they undergo a procedure for permanent implantation,” Hull said.
Your clinician will discuss the treatment options that apply to your unique situation, along with any potential risks or side effects. The bottom line is that there are several treatment options for incontinence that can help improve your quality of life.
Back to a fuller life
As women’s health and urogynecology experts, the Urogynecology and Pelvic Reconstructive Surgery team at Vanderbilt offers personalized care for females experiencing bladder-related symptoms and conditions. These experts are here to help find answers and treatment so you can live a fuller life. Call 615-343-5700.
