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 refers to an inability to control peeing.)
Incontinence treatment options can help reduce symptoms. Treatments fall into two categories: nonsurgical (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.
Both surgical and nonsurgical treatments can help with stress and urge incontinence.
“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
Certain behavioral modifications can help with urge incontinence, which is leakage when you feel the need to go.
“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 technique is to avoid or cut back on things that can irritate the bladder.
“Irritants may include caffeinated beverages, alcoholic beverages and beverages with a lot of sugars or artificial sweeteners,” Hull said. “I often recommend to patients a reduction of the daily intake of coffee, sodas and teas.”
Changing how much fluid you drink, and when, can also help.
“If a person is taking in too much fluid volume, they may want to modify that for a more moderate daily intake,” Hull said.
A person can also change their drinking schedule by stopping fluid intake two hours before bedtime, to reduce the need to urinate during the night.
Another strategy is changing urination schedule (or “voiding” schedule) by using the restroom at regular or timed intervals.
“If patients feel like they have to go all the time, they may want to practice some techniques,” Hull said, “such as urge suppression or time voiding, to try to help retrain the bladder, so it’ll be a little bit less urgent.”
Stress incontinence refers to leaking urine when you sneeze, cough, laugh or make some other sudden move that puts stress on the bladder.
If you experience both urge and stress incontinence, physical therapy may help. A physical therapist who specializes in the pelvic floor health can teach you how to do Kegel exercises and techniques using 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 as needed, such as during exercise when leakage may be most bothersome. Hull said she often fits people for these devices in the office.
Medication can help
Medication can also be a good option for those who have urgency and frequency problems without leakage or urge incontinence.
“We have medications from two specific classes of drugs that can help reduce urgency, frequency and urge incontinence,” Hull said. Those drug classes are called anticholinergic, and antimuscarinic.
“Anticholinergic or antimuscarinic medications act on certain receptors in the bladder to help calm the bladder down a bit,” Hull explained.
“Beta-3 agonist medications work on a different receptor to achieve the same result and may have fewer bothersome side effects,” she added. They help relax the bladder, to soothe the urge to urinate.
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.
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.
“Patients must first 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 bladder-related symptoms and conditions. These experts are here to offer treatment that lets you live a a fuller life. Call 615-343-5700 for an appointment.
