Treatment:

Treatment depends on how severe the symptoms are and how much they interfere with your everyday life.

The doctor may ask that you stop smoking (if you smoke) and avoid caffeinated beverages (such as soda) and alcohol. You may be asked to keep a urinary diary, recording how many times you urinate during the day and night, and how often urinary leaking occurs.

There are four major categories of treatment for stress incontinence:

• Behavioral changes
• Medication
• Pelvic floor muscle training
• Surgery

BEHAVIORAL CHANGE

Examples of behavior changes include:

• Decreasing any excessive fluid intake (you should not decrease your fluid intake if you drink normal amounts of fluid)
• Urinating more frequently to decrease the amount of urine that leaks
• Changing physical activities to avoid jumping or running movements, which can cause more urine leakage
• Regulating bowel movements with dietary fiber or laxatives to avoid constipation (which can worsen incontinence)
• Quitting smoking to reduce coughing and bladder irritation (and your risk of bladder cancer)
• Avoiding alcohol and caffeine, which can overstimulate the bladder
• Losing weight if you are overweight
• Avoiding food and drinks that irritate the bladder, such as spicy foods, carbonated beverages, and citrus
• Keeping blood sugar under control if you have diabetes

PELVIC FLOOR MUSCLE TRAINING

Pelvic muscle training exercises (called Kegel exercises) may help control urine leakage. These exercises improve the strength and function of the urethral sphincter.

Some women may use a device called a vaginal cone along with pelvic exercises. The cone is placed into the vagina, and the woman tries to contract the pelvic floor muscles in an effort to hold it in place. The device may be worn for up to 15 minutes. This procedure should be done two times a day. Within 4 - 6 weeks, most women have some improvement in their symptoms.

Biofeedback and electrical stimulation may be helpful for those who have trouble doing pelvic muscle training exercises. These two methods can help you identify the correct muscle group to work. Biofeedback is a method that helps you learn how to control certain involuntary body responses.

Electrical stimulation therapy uses low-voltage electrical current to stimulate and contract the correct group of muscles. The current is delivered using an anal or vaginal probe. The electrical stimulation therapy may be done at the doctor's office or at home.

Treatment sessions usually last 20 minutes and may be done every 1 - 4 days. Newer techniques are being investigated, including one that uses a specially designed electromagnetic chair that causes the pelvic floor muscles to contract when the patient is seated.

MEDICATIONS

Medicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include:

• Anticholinergic agents (oxybutynin, tolterodine, enablex, sanctura, vesicare, oxytrol)
• Antimuscarinic drugs block bladder contractions (many doctors prescribe these types of drugs first)
• Alpha-adrenergic agonist drugs, such as phenylpropanolamine and pseudoephedrine (common ingredients in over-the-counter cold medications), help increase sphincter strength and improve symptoms in many patients
• Imipramine, a tricyclic antidepressant, works in a similar way to alpha-adrenergic drugs

Estrogen therapy can be used to improve urinary frequency, urgency, and burning in postmenopausal women. It also can improve the tone and blood supply of the urethral sphincter muscles.

However, whether estrogen treatment improves stress incontinence is controversial. Women with a history of breast or uterine cancer usually should NOT use estrogen therapy for the treatment of stress urinary incontinence.

SURGERIES

Surgical treatment is only recommended after the exact cause of the urinary incontinence has been determined. Most of the time, your doctor will try bladder retraining or Kegel exercises before considering surgery.

• Anterior vaginal repair or paravaginal repair procedures are often done in women when the bladder is bulging into the vagina (a condition is called a cystocele). Anterior repair is done through a surgical cut in the vagina, and a paravaginal repair is done through a surgical cut in the vagina or abdomen
• Artificial urinary sphincter is a surgical device used to treat stress incontinence mainly in men (rarely in women)
• Collagen injections make the area around the urethra thicker, which helps control urine leakage (the procedure may need to be repeated after a few months to achieve bladder control)
• Retropubic suspension are a group of surgical procedures done to lift the bladder and urethra. They are done through a surgical cut in the abdomen. The Burch colposuspension and Marshall-Marchetti-Krantz (MMK) procedures differ based on the structures that are used to anchor and support the bladder
• Tension-free vaginal tape
• Vaginal sling procedures are often the first choice for the treatment of uncomplicated stress incontinence in women (it is rarely done in men). A sling made of synthetic material is placed so that it supports the urethra

Most health care providers advise their patients to try other treatments before having surgery.

Depending on the success of treatment and other medical problems the person may have, some people may require a urinary catheter to drain urine from the bladder.

Expectations (prognosis):

Behavioral changes, pelvic floor exercise therapy, and medication usually improve symptoms rather than cure stress incontinence. Surgery can cure most carefully selected patients.

Treatment does not work as well in people with:

• Conditions that may prevent healing or make surgery more difficult
• Other genital or urinary problems
• Previous surgical failures

Complications:

Complications are rare and usually mild. They can include:

• Erosion of surgically placed materials such as a sling or artificial sphincter
• Fistulas or abscesses
• Irritation of the vulva (vaginal lips)
• Pain during intercourse
• Skin breakdown and pressure ulcers in bed- or chair-bound patients
• Unpleasant odors
• Urinary tract infections
• Vaginal discharge

The condition may affect or disrupt social activities, careers, and relationships.

Calling your health care provider:

Call for an appointment with your health care provider if you have symptoms of stress incontinence and they are bothersome.