Urinary Incontinence in Women

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
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• Urinary incontinence is the accidental release of urine. It is not a serious health problem, but it can be embarrassing.
• The treatment you need depends on what is causing the problem. Treatment may include exercises, a removable device to strengthen the urinary tract, medicines, or surgery.
• At home, you can try going to the bathroom at set times and completely emptying your bladder when you urinate.
• If you smoke, your doctor may advise you to quit. Coughing from smoking puts more pressure on the bladder, which can make the problem worse.

What is urinary incontinence?

Urinary incontinence is the accidental release of urine. It can happen when you cough, laugh, sneeze, or jog. Or you may have a sudden need to go to the bathroom but can't get there in time. Bladder control problems are very common, especially among older adults. They usually do not cause major health problems, but they can be embarrassing.

Incontinence can be a short-term problem caused by a urinary tract infection, a medicine, or constipation. It gets better when you treat the problem that is causing it. But this topic focuses on ongoing (chronic) urinary incontinence.

There are two main kinds of chronic incontinence. Some women have both.

• Stress incontinence occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladder. It is the most common type of bladder control problem in women.
• Urge incontinence happens when you have a strong need to urinate but can't reach the toilet in time. This can happen even when your bladder is holding only a small amount of urine. Some women may have no warning before they accidentally leak urine. Other women may leak urine when they drink water or when they hear or touch running water. Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine.

Mixed incontinence is a combination of different types of bladder control problems, usually stress and urge incontinence. These problems often occur together in older women.

What causes urinary incontinence?

Chronic bladder control problems may be caused by:

• Weak muscles in the lower urinary tract. See a picture of the urinary tract.
• Problems or damage either in the urinary tract or in the nerves that control urination.

See a picture of the organs inside the pelvis.

Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch the pelvic floor muscles. When these muscles cannot support your bladder properly, the bladder drops down and pushes against the vagina. You cannot tighten the muscles that close off the urethra. So urine may leak because of the extra pressure on the bladder when you cough, sneeze, laugh, exercise, or do other activities.

Urge incontinence is caused by an overactive bladder muscle that pushes urine out of the bladder. It may be caused by irritation of the bladder, emotional stress, or brain conditions such as Parkinson's disease or stroke. Many times doctors don't know what causes it.

What are the symptoms?

The main symptom of urinary incontinence is the accidental release of urine.

If you have stress incontinence, you may leak a small to medium amount of urine when you cough, sneeze, laugh, exercise, or do similar things.

If you have urge incontinence, you may feel a sudden urge to urinate and the need to urinate often. With this type of bladder control problem, you may leak a larger amount of urine that can soak your clothes or run down your legs.

If you have mixed incontinence, you may have symptoms of both problems.

How is urinary incontinence diagnosed?

Your doctor will ask about what and how much you drink. He or she will also ask how often and how much you urinate and leak. It may help to keep track of these things for 3 or 4 days before you see your doctor.

Your doctor will examine you and may do some simple tests to look for the cause of your bladder control problem. If your doctor thinks it may be caused by more than one problem, you will likely have more tests.

How is it treated?

Most bladder control problems can be improved or cured.

Treatment for stress incontinence includes:

• Doing Kegel exercises to strengthen the pelvic floor muscles. It is one of the best ways to improve stress incontinence.
• Using a removable device called a pessary (which is placed inside the vagina). It can help reduce stress incontinence by putting pressure on the urethra.
• Taking medicines, but they may have bothersome side effects.
• Having surgery to support the bladder or move it back to a normal position, if other treatment doesn't help.

For urge incontinence, your doctor may:

• Suggest behavior changes to fix the problem. For example, bladder training helps you to increase how long you can wait before you have to urinate.
• Prescribe medicine to treat urge bladder problems.

If you have more than one kind of bladder control problem, first your doctor will treat the one that bothers you the most. Then he or she will treat the other cause, if needed.

Your doctor may suggest things you can do at home, such as going to the bathroom at set times and completely emptying your bladder when you urinate.

It may also help to cut back on caffeine drinks, such as coffee, tea, or sodas.

How can you prevent urinary incontinence?

Strengthening your pelvic muscles with Kegel exercises may lower your risk for incontinence.

If you smoke, think about quitting. Quitting may make you cough less, which may help with incontinence.

Frequently Asked Questions

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Stress incontinence: Should I have surgery?

The causes of the most common types of urinary incontinence are:

• Stress incontinence.Stress incontinence is caused by stretched pelvic floor muscles, as from childbirth or weight gain. When these muscles no longer support your bladder properly, the bladder drops downward and pushes against the vagina, preventing tightening of the muscles that ordinarily close off the urethra. Leakage can then occur when extra pressure is exerted with coughing, sneezing, laughing, or other activities. Stress incontinence may get worse with the drop in estrogen that comes after menopause. A chronic cough from smoking can also make stress incontinence worse.
• Urge incontinence. Urge incontinence results when the bladder muscle involuntarily contracts. Urge incontinence can be caused by:
  • Age-related changes in the bladder muscle.
  • Parkinson's disease.
  • Stroke.
  • Kidney or bladder stones.
  • Tumors that put pressure on the bladder, such as pelvic, cervical, or uterine cancer.
  • Tumors that irritate the lining of the bladder (bladder cancer).

Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine. For more information, see the topic Overactive Bladder.

It is common for a woman to have mixed incontinence, usually a combination of stress incontinence and urge incontinence.

Less common types of urinary incontinence have other causes. These types include:

• Overflow incontinence. Overflow incontinence is the involuntary release of urine when the bladder becomes overly full due to a blockage, but you feel no urge to urinate. This is uncommon in women.
• Total incontinence. Total incontinence is the continuous and total loss of urinary control. There can be many causes for total incontinence, including neurogenic bladder, an involuntary contraction of the bladder that forces the release of urine, as well as spinal cord injuries, multiple sclerosis, and other disorders that affect nerve function.
• Functional incontinence. Functional incontinence occurs when a disability, such as dementia or arthritis, makes it difficult for you to reach or use a bathroom in time to urinate.
• Anatomical incontinence. Anatomical incontinence is the involuntary release of urine related to structural problems of the urinary tract that affect the urine flow. Anatomical incontinence may be present from birth (congenital).

The main symptom of urinary incontinence is a problem controlling urination. The circumstances and type of problem affecting urination vary with the cause.

Symptoms of stress incontinence involve the involuntary release of urine, especially when coughing, sneezing, or laughing. It is the most common type of urinary incontinence in women. It usually results in a small to moderate amount of urine leaked.

Symptoms of urge incontinence include the need to urinate frequently and a sudden, urgent, and uncontrollable need to urinate. It can result in a moderate to large amount of urine leaked, although it often occurs when the bladder contains only a small amount of urine.

It is common for a woman to have mixed incontinence, usually a combination of stress and urge incontinence.

To find out what type of incontinence you may have, ask yourself the following questions.

If you answered "Yes" to one or more questions in the top table, you may have stress incontinence. If you answered "Yes" to one or more questions in the bottom table, you may have urge incontinence. You may have mixed incontinence if you answered "Yes" to one or more questions in each section.

Urinary incontinence that often appears suddenly and usually clears up when the underlying cause is treated is called temporary incontinence. For example, incontinence resulting from a urinary tract infection will disappear when the infection is cured.

Long-term (chronic) incontinence usually starts gradually and slowly becomes worse. As incontinence gets worse, a woman may:

• Avoid going out in public because of embarrassment.
• Become less active.
• Have physical problems caused by frequent urine contact, such as irritation of the groin area and more frequent urinary tract infections.

Treating the cause of chronic incontinence often eliminates or controls these problems.

Sometimes several factors combine to cause urinary incontinence. For example, a woman may have had multiple childbirths, be older, and have a severe cough because of chronic bronchitis or smoking, all of which might contribute to her incontinence problem.

Physical conditions that make urinary incontinence more likely include:

• Pregnancy and vaginal delivery.
• Having had a hysterectomy.
• Obesity or being overweight.
• Older age.
• Bladder stones.
• A drop in estrogen after menopause.
• Structural abnormalities of the urinary tract.
• Blockage of the bladder.
• Chronic bladder infections.

Diseases and conditions that may result in urinary incontinence include:

• Chronic cough due to smoking or bronchitis.
• Diabetes.
• Parkinson's disease.
• Alzheimer's disease.
• Multiple sclerosis.
• Bladder cancer.
• Stroke.
• Spinal cord injury.

Urinary incontinence may be made worse by:

• Medicines that increase urine production, such as diuretics, or those that relax the bladder, such as bronchodilators.¹
• Caffeinated beverages, such as coffee, tea, or some soda pop. (Caffeine affects urgency and how often you urinate.²)
• Smoking, which is often the start of a chronic cough and subsequent incontinence.³

Call your doctor if:

• You have urinary incontinence that begins suddenly (acute incontinence). Acute incontinence is often caused by urinary tract problems or medications and can be easily corrected.
• The involuntary release of urine is enough of a problem that you need to wear an absorbent pad, or if incontinence interferes with your life in any way.

Do not be embarrassed to discuss urinary incontinence with your health professional. Urinary incontinence is not an inevitable result of aging. Most women with incontinence can be helped or cured.

Watchful Waiting

If you have urinary incontinence that develops slowly (chronic incontinence), you may be able to control the problem yourself. (For more information, see the Home Treatment section in this topic.) If home treatment is not effective, or if incontinence interferes with your lifestyle, ask your health professional about other treatments.

Who To See

Health professionals who can diagnose and treat urinary incontinence include:

• Family medicine doctors.
• Physician assistants.
• Nurse practitioners.
• Obstetricians/gynecologists (OB/GYN).

Your health professional may want you to see a doctor who specializes in problems of the urinary tract (urologist) or who specializes in treating older people (geriatrician).

If you need surgery, it is important to find a surgeon who is experienced in the types of surgical procedures used to treat incontinence.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

To diagnose the cause of your urinary incontinence, your doctor will ask about your medical history and do a physical examination, including a pelvic exam. Your doctor may ask you to cough while you are standing to check for stress incontinence. In addition, a urinalysis and urine culture may be done to see if you have a urinary tract infection (UTI).

An accurate diagnosis is very important, because treatment based on an incorrect diagnosis may not help your incontinence and could even make it worse.

Your doctor will ask you about your symptoms and habits, for example, how often you need to urinate, when you leak urine, how much fluid and what kinds of fluids you drink, and whether you have any other symptoms along with incontinence. Your answers will provide clues about the cause of your incontinence.

Ideally, you will bring your doctor a 3- to 4-day diary of what and how much you drink, and how often and how much you urinate and leak. The pattern of your urine leakage may point to the type of incontinence.

View and print a voiding log(What is a PDF document?).

Other procedures that may be done include:

• Bladder stress test and Bonney test. For the bladder stress test, your doctor will insert fluid into your bladder and then check for leaking after asking you to cough. The Bonney test is similar to the bladder stress test except the bladder neck is lifted slightly with a finger or instrument inserted into your vagina while the bladder stress is applied.
• Pad test. A pad test can show how much urine you are passing and how often throughout the day. This is helpful when incontinence cannot be triggered during an exam.

Urodynamic testing

Urodynamic testing is expensive. It is generally done only if surgery is being considered or if treatment has not worked for you and you need to know more about the cause. It provides a more advanced way to check bladder function. Urodynamic testing may be done if the above tests do not give an answer to why you have leakage of urine or your health professional suspects that you have mixed incontinence with more than one cause. The actual tests done in urodynamic testing often vary. They may include:

• Cystometry (cystometrography, uroflowmetry), which is a series of tests to measure bladder pressure at different levels of fullness. Cystometry tests include:
  • Leak point pressure (LPP), which measures weakness in the muscle that holds back urine (sphincter).
  • Maximum urethral closure pressure (MUCP), which measures the pressure keeping the urethra closed naturally.
• Postvoid residual (PVR) measurements and X-rays or ultrasound. These are used to examine changes in the position of the bladder and urethra during urination, coughing, or straining.

If the cause of incontinence is not identified by the above tests, more extensive tests may be needed. The following tests are not routinely done to diagnose urinary incontinence.

• Cystoscopy uses a scope to look inside the urethra and the bladder for abnormalities.
• Voiding cystourethrogram is an X-ray that uses an iodine-containing contrast liquid to show the shape of the lower urinary tract (bladder and urethra). This may make visible any physical abnormalities of the urinary tract that could be contributing to incontinence.

There are several possible treatments for urinary incontinence. The best treatment depends on the cause of your incontinence and your personal preferences.

Key points

• Most of the time, incontinence can be cured or at least managed.
• For stress incontinence, many women get good results from using Kegel exercises, timed urination training, lifestyle changes, and medical devices such as pessaries. You have the best chance of success when you stick with them. For difficult-to-treat stress incontinence, surgery can help. New surgical techniques are minimally invasive and can have quick recovery times.
• For urge incontinence, learning to retrain the bladder is often helpful. Medicines may also help, although they tend to have bothersome side effects. Surgery is not considered an effective treatment for urge incontinence.¹

View and print a voiding log(What is a PDF document?) for keeping track of your symptoms.

Exercises and lifestyle changes

Pelvic floor (Kegel) exercises help 50% to 75% of women to decrease the occurrence of stress incontinence.³ These exercises, which strengthen the pelvic muscles involved in urination, are especially useful for stress incontinence, but may also help urge incontinence. Making sure you do these exercises correctly and doing them regularly are key in succeeding with this method.

Kegel exercises may be combined with biofeedback techniques to help you know whether you are tightening the right muscles. This can also be done by placing a finger in your vagina so that you can feel the pelvic muscles contract. Also, to prevent leakage when you feel a sneeze or cough coming, try a Kegel by tightening your pelvic floor muscles. Crossing your legs may also help.

Losing weight often helps stress incontinence.

Sometimes making lifestyle changes can help with urge incontinence. Try to identify any foods that might irritate your bladder—including citrus fruits, chocolate, tomatoes, vinegars, dairy products, aspartame, and spicy foods—and cut back on them. Also, avoiding alcohol and caffeine usually helps.

Behavioral methods

Three types of behavioral methods are used to treat urinary incontinence: bladder training, timed urination, and prompted voiding.

Bladder training (also called bladder retraining) is used to treat urge incontinence. With bladder training, you increase how long you can wait before having to urinate by trying to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. Then try increasing the waiting period to 20 minutes. The goal is to lengthen the time between trips to the toilet until you're urinating every 2 to 4 hours.

Your doctor might instruct you to try timed urination if you urinate infrequently. You will urinate every 2 to 4 hours during waking hours, even if you feel as though you don't have to go. This method can be effective for both urge and stress incontinence.

Prompted voiding requires a caregiver to prompt the person to urinate. This technique is used mostly for people with a disability that gets in the way of using the bathroom on their own (functional incontinence).

Medicines

If exercise and behavioral therapies are not successful, your doctor might combine these treatments with medicines. (Taking a medicine by itself rarely cures incontinence.⁴)

• Anticholinergic medicines relax the bladder and increase bladder capacity. Examples include oxybutynin and tolterodine. These medicines are most frequently prescribed for urge incontinence. They often are effective, but they can cause side effects, including dry mouth, constipation, blurred vision, and an inability to urinate. Newer medicines, including time-release and skin-patch formulas, may have fewer side effects.
• Certain antidepressant medicines may also be used to treat urge or stress incontinence. An antidepressant may be used in combination with an anticholinergic medicine.

Medical devices

A pessary is a rubber device that is inserted into the vagina until it touches the cervix. The pessary presses through the vaginal wall and supports the urethra. It also pinches the urethra closed to help retain urine in the bladder and decrease stress incontinence. Some women with stress incontinence use a pessary just during activities that are likely to cause urine leakage, such as jogging. But many pessaries can be worn all the time. If you use a pessary, watch for possible vaginal and urinary tract infections, and see your doctor regularly. See the Other Treatment section of this topic for information about other medical devices.

Surgery

Stress incontinence that does not respond to medicine or exercise therapy is often treated surgically. (Surgery is typically not done for urge incontinence.)

If there may be additional causes of incontinence (mixed incontinence), a complete evaluation and further testing may be done before surgery is considered.

Discuss with your doctor which symptoms the surgery is designed to treat. Other symptoms may remain after surgery. If you have mixed incontinence, surgery may cure stress incontinence, but it may not improve urge incontinence. It may even make urge incontinence worse.

The tension-free vaginal tape (TVT) surgery is often used for stress incontinence. During this surgery, a meshlike tape is positioned under the urethra like a sling or a hammock to support it and return it to its normal position. The surgeon inserts the tape through small incisions in your vagina and pubic hair line. TVT surgery takes approximately 30 minutes and is usually done under local anesthesia. This surgery can also be done to correct incontinence that has come back after having another type of incontinence surgery. Another surgery called transobturator tape (TOT) surgery is like TVT surgery.

More invasive surgeries include the retropubic suspension surgery and the sling surgery. These surgeries support your pelvic organs and correct stress incontinence. Both require general anesthesia and hospitalization.

For women with stress incontinence who cannot have surgery, a simpler procedure called urethral bulking may be done. In this procedure, a urologist injects collagen or other bulking materials around the urethra to build up the urethra where it leaves the bladder. This procedure usually relieves symptoms for a short time, but you will probably need 2 or 3 injections.⁵

Which treatment for stress incontinence is right for me?

Treatment varies for less common types of urinary incontinence, such as overflow incontinence, total incontinence, functional incontinence, and anatomical incontinence.

What To Think About

Behavioral methods, exercises and lifestyle changes, and medicines are usually tried first before more invasive methods are tried to confirm the cause of incontinence. If the problem gets better, the diagnosis is confirmed. If the problem does not get better, your doctor may try another treatment or do more tests.

Incontinence can have more than one cause (mixed incontinence). When this is the case, the most significant cause is treated first, followed by treatment for the secondary cause, if needed.

You may reduce your chances of developing urinary incontinence by:

• Doing pelvic floor (Kegel) exercises to strengthen your pelvic muscles.
• Stay at a healthy weight. For more information, see the topic Weight Management.
• Quitting smoking. Smoking causes coughing, which can make it harder to control your urine. Quitting smoking makes coughing better. For more information, see the topic Quitting Smoking.

If you experience long-term (chronic) urinary incontinence, you can take some steps immediately that may eliminate or reduce the problem.

• Establish a schedule of urinating every 2 to 4 hours, regardless of whether you feel the need.
• Talk with your doctor about all prescription and nonprescription medicines you take, to see if any of them may be making your incontinence worse.
• Practice "double voiding" by urinating as much as possible, relaxing for a few moments, and then urinating again.
• If you have trouble reaching the bathroom before you urinate, consider making a clearer, quicker path to the bathroom and wearing clothes that are easily removed (such as those with elastic waistbands or Velcro closures), or keep a bedpan close to your bed or chair.
• Reduce or eliminate caffeinated drinks (coffee, tea, and some carbonated drinks) from your diet.
• Avoid drinking alcohol in excess.
• Wear a tampon while doing activities such as jogging or dancing to put a little pressure on your urethra and to temporarily slow or stop leakage.
• Avoid drinking too much or too little fluid. Excessive liquids can increase the need to urinate and increase incontinence. Too little fluid can result in dehydration. Approximately 2 qt (1.89 l) of fluid are necessary every day to maintain kidney and bladder health.

Additional steps may reduce or eliminate your urinary incontinence, but these require more time to make a difference.

• Strengthen your pelvic muscles by performing pelvic floor (Kegel) exercises every day and by having a regular exercise program.
• Try to lose some weight if you are overweight. Remember that effective weight-loss programs depend on a combination of diet and exercise. For more information, see the topics Weight Management, Fitness, and Healthy Eating.
• Increase the amount of fiber in your diet if constipation is a problem. You can easily do this by adding a small amount of wheat bran, such as 1 tsp (4.7 g), to foods you normally eat and by increasing the amount of fruits, vegetables, whole grains, and beans in your diet.
• If you smoke, quit. This may reduce coughing, which may reduce your problem with incontinence. For more information, see the topic Quitting Smoking.

Urinary incontinence may be treated with medicines. But in many cases treatment with behavioral methods (for urge incontinence) and Kegel exercises (for stress incontinence) are tried before medicines.

Even when medication treatment helps with incontinence, there may be side effects or interactions with other medicines.

Medication Choices

For stress incontinence, medicine choices may include:

• Antidepressant medicine (duloxetine or imipramine). Duloxetine can help control stress incontinence. Studies show that duloxetine reduces the number of times women have stress incontinence.⁶ How it works is not known. Imipramine causes the bladder muscle to relax while also causing the muscles at the bladder neck to contract. There are no well-done studies of imipramine for incontinence. But it reportedly works for some women.

Treatment for urge incontinence may include:

• Anticholinergic medicines, such as Detrol, Ditropan, and Oxytrol. These often are effective for urge incontinence, but they have side effects that include dry mouth, constipation, blurred vision, and an inability to urinate. Time-release and skin-patch formulas may have fewer side effects.
• Imipramine (such as Tofranil), an antidepressant medicine that may be used to treat both urge and stress incontinence. It is often used in combination with an anticholinergic medicine.

What To Think About

Medicine is often used in combination with behavioral methods. For more information on behavioral methods, see the Other Treatment section in this topic.

Hormone therapy. Do not use hormone replacement therapy (HRT) to treat stress incontinence. One large study found that more women taking estrogen for a year had urinary incontinence problems than women who took no hormones.⁷ And other studies have found that estrogen has no effect on incontinence.⁸

Applying a small amount of estrogen cream just inside the vagina may help some menopausal women with urge incontinence.³ But this has not been well-studied.

There are several different kinds of surgeries to correct stress incontinence, which results when weakened pelvic floor muscles allow the bladder neck and urethra to drop. These surgeries seek to lift the urethra and/or bladder into the normal position. This makes sneezing, coughing, and laughing less likely to make urine leak from the bladder.

Surgery is usually not done for urge incontinence.

The decision to have surgery must always be based on an accurate diagnosis, consideration of other treatment possibilities, and realistic expectations for the surgery.

Surgery Choices

• Tension-free vaginal tape (TVT) surgery. TVT surgery is commonly used for stress incontinence. During this surgery, a meshlike tape is positioned under the urethra like a sling or a hammock to support it and return it to its normal position. The surgeon inserts the tape through small incisions in your vagina and pubic hair line. TVT surgery takes approximately 30 minutes and is usually done under local anesthesia. This surgery can also be done to correct incontinence that has come back after having another type of incontinence surgery. Another surgery called transobturator tape (TOT) surgery is like TVT surgery.
• Retropubic suspension. The Marshall-Marchetti-Krantz (MMK) and Burch colposuspension procedures are the most common types of retropubic suspension. Retropubic surgeries provide lift to the sagging bladder neck and urethra by attaching their supporting tissues to the pubic bone or tough ligaments. These surgeries require hospitalization.
• Urethral sling. The surgeon fashions a piece of muscle, ligament, or tendon tissue or synthetic material into a sling that lifts the urethra back into a normal position. This involves abdominal surgery, so hospitalization is required.

What To Think About

Factors that may decrease the effectiveness of surgical treatment include obesity, long-term (chronic) cough, radiation therapy, aging, low estrogen level after menopause, poor nutrition, and strenuous physical activity.

Most surgical failures are due to incorrect diagnosis. Other reasons for failure include surgery that is not done well, healing problems, obesity, and additional causes of incontinence that could not be identified before correcting the primary cause.

Changes in habits (behavioral methods) and exercise are often used first to treat urinary incontinence because they do not involve surgery, have no serious side effects, can be done at home, and do not limit future treatment options. These methods are often successful in treating mild to moderate incontinence.

• Acupuncture: Acupuncture has been studied for improving urge incontinence, with promising results. In one well-done study, four weekly acupuncture treatments greatly improved women's urge incontinence, along with how much and how often they urinated.⁹
• Behavioral methods: These methods, which include bladder training and timed voiding, are used to treat urge incontinence.
• Exercises: Pelvic floor, or Kegel, exercises strengthen the pelvic muscles involved in urination and are used to treat stress or urge incontinence.
• Electrical stimulation: Electrical stimulation treatment uses a mild electrical current to stimulate the pelvic muscles that are involved in urination. Although not well-studied, this method seems to be more effective for urge incontinence than for stress incontinence.¹⁰
• Mechanical devices: These devices include a pessary, which is a rubber device that is inserted into the upper vagina to lift the bladder to help control stress incontinence, and a catheter, which is a thin, flexible tube that a woman inserts into her bladder to drain urine (in a process called intermittent self-catheterization) to help control overflow incontinence.
• Absorbent products: These include adult diapers, plastic-coated underwear, pads, or panty liners that attach to underwear.
• Urethral bulking: Urethral bulking involves injecting collagen or other bulking materials around the urethra to build up the urethra where it leaves the bladder. This procedure usually relieves symptoms for a short time, but you will probably need 2 or 3 injections.⁵

Before trying other treatment options for urinary incontinence, ask your doctor the following questions:

• Is behavioral or exercise therapy alone likely to restore continence? Mild to moderate cases of common types of incontinence can be cured or greatly improved by these methods.
• How long should behavioral or exercise techniques be tried before surgery or other treatment methods should be considered? Since techniques like Kegel exercises do not limit future treatment options (and may even improve the odds of success for other treatments), it is best to set a length of time after which the improvement can be evaluated.
• Can exercises or behavioral methods be used in combination with medicine if medication treatment is recommended? It may be possible to shorten medication therapy or to reduce the amount of medicines used if other methods of treatment are combined with medication therapy.

Organizations

Related Information

• Overactive Bladder
• Urinary Incontinence in Men
• Urinary Tract Infections in Teens and Adults

Citations

1. Lentz GM (2007). Physiology of micturition, diagnosis of voiding dysfunction, and incontinence: Surgical and nonsurgical treatment. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 537–568. Philadelphia: Mosby Elsevier.

2. American College of Obstetricians and Gynecologists (2005, reaffirmed 2007). Urinary incontinence in women. ACOG Practice Bulletin No. 63. Obstetrics and Gynecology, 105(6): 1533–1545.

3. Sutherland SE, Goldman HB (2004). Treatment options for female urinary incontinence. Medical Clinics of North America, 88(2): 345–366.

4. Norton P, Brubaker L (2006). Urinary incontinence in women. Lancet, 367: 57–67.

5. Keegan PE, et al. (2007). Periurethral injection therapy for urinary incontinence in women. Cochrane Database of Systematic Reviews (3).

6. Onwude J (2007). Stress incontinence, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

7. Hendrix SL, et al. (2005). Effects of estrogen with and without progestin on urinary incontinence. JAMA, 293(8): 935–948.

8. Grady D, et al. (2001). Postmenopausal hormones and incontinence: The Heart and Estrogen/Progestin Replacement Study. Obstetrics and Gynecology, 97(1): 1116–1120.

9. Emmons SL, Otto L (2005). Acupuncture for overactive bladder. Obstetrics and Gynecology, 106(1): 138–143.

10. Holroyd-Leduc JM, Straus SE (2004). Management of urinary incontinence in women. JAMA, 291(8): 986–995.

Other Works Consulted

• Barber MD, et al. (2008). Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence. Obstetrics and Gynecology, 111(3): 611–621.

• Tanagho EA, et al. (2008). Urinary incontinence. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 473–489. New York: McGraw-Hill Medical.