Treating Incontinence

You don’t have to live with the discomfort of urinary incontinence. You can work with your health care provider to create a personalized plan to meet your needs and treat your type of incontinence. Here are some options that might help.

Lifestyle modifications

You can take steps to minimize or eliminate episodes of incontinence:

• Train your bladder. Bladder training means scheduling times to urinate. You can improve your bladder control by gradually increasing the length of time between bathroom visits. Most people try to urinate every 2.5 to 3.5 hours.
• Empty your bladder completely. With a technique called double voiding, you urinate, wait several minutes and try again.
• Empty your bladder before physical activity.
• Avoid lifting heavy objects.
• Distract yourself by holding still, taking deep breaths and tightening your pelvic floor muscles to hold back an urge to urinate until you can get to the bathroom.
• Control the amount of fluid you drink, but don’t cut back on liquids drastically. Aim for six to eight 8-ounce glasses of water a day unless your doctor recommends otherwise.
• Limit caffeine and alcohol.
• Quit smoking.
• Make changes to your diet to reduce bladder irritation. It can help to avoid carbonated drinks, chocolate, chili peppers and other spicy foods, high-sugar foods, artificial sweeteners and acidic foods like citrus fruit. Eating more fiber can also help if constipation is causing incontinence.
• Lose excess weight, which can lower pressure on the bladder and help you control urination. Losing just 5% of your body weight can make a difference.
• Make sure your path to the bathroom is clear and use nightlights in case you wake up to urinate.

Pelvic floor exercises

You can strengthen your pelvic floor muscles to improve bladder control by performing regular Kegel exercises. A pelvic floor physical therapist can help you make sure you’re exercising the right muscles.

You can also use biofeedback therapy, where sensors provide feedback on your pelvic floor muscle contractions so you can learn how to control those muscles properly. You may need to do these exercises for four to 12 weeks (one to three months) before you start to see results, then keep doing them regularly to stop incontinence.

Medications

Depending on the type of incontinence, your doctor may recommend prescription medications that can relax the bladder, reduce your urge to urinate or strengthen the pelvic floor muscles.

Options include:

• Anticholinergics such as oxybutynin (Ditropan or Oxytrol), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura)
• Mirabegron (Myrbetriq) and vibegron (Gemtesa) 
• Alpha-blockers such as tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), and doxazosin (Cardura), which are used in men since they affect the prostate
• Topical estrogen, used in women and applied in the vaginal area

Medical devices

Several devices  can help you control the flow of urine:

• A pessary (a removable device you insert into your vagina to help support the bladder) can help with stress incontinence.
• If your bladder doesn’t empty properly, you may need to drain your urine with a catheter several times a day.

Interventional therapies

There are several medical treatments that can help control incontinence:

• Percutaneous tibial nerve stimulation (PTNS) uses electrical stimulation of a nerve that controls bladder function to help improve urinary control.
• Electrical stimulation in your vagina or rectum can help strengthen pelvic floor muscles.
• Sacral nerve stimulation uses a device implanted in your buttock to stimulate the nerves that help with bladder control.
• Bulking agents injected around the urethra can help it better hold urine and reduce stress incontinence. You may feel a burning sensation for a short time after the procedure, and you could need to repeat these injections.
• Botulinum toxin (Botox) injections in the bladder muscle can relax overactive bladder muscles and reduce incontinence. It can be an option if other treatments don’t work. These injections may need to  be repeated around every six months.

Surgical procedures

If other types of treatment don’t work, your provider may recommend surgery:

• Slings use your body tissue or a synthetic mesh to help keep your urethra closed. It’s usually done in a same-day procedure. It usually works well, but some people have pain or other complications from the synthetic mesh.
• Prolapse surgery repairs pelvic organ prolapse. It can be done at the same time as a sling. 
• Bladder neck suspension (also known as colposuspension or a Burch procedure) adds support to the area where your bladder and urethra connect.
• Artificial urinary sphincter placement puts a ring filled with fluid around your urethra . When you need to urinate, you temporarily deflate the ring by pressing on a valve under your skin. It’s used more often in men than in women.

Absorbent products

If your incontinence is not treatable, you can use incontinence pads, guards, protective underwear or other absorbent products to manage and contain urine leakage.

Choose products designed to absorb urine (not feminine hygiene products) since they give you more protection against leaks and odor. Be sure to change these products when wet, since wearing them too long can lead to unpleasant odors, skin irritation, sores or infection.