Urinary Incontinence

Care & Treatment

Stepped Approach to Treatment

Be sure to tell your healthcare provider which aspects of urinary incontinence (UI) are most troublesome to you so they can focus on resolving those issues and explain what you can expect from treatment.
The type of treatment your healthcare provider recommends will depend on the type of UI you have and the causes. Often, treatment is handled in a “stepped approach” that begins with addressing any medication or health problems that may be contributing to UI. After that, the next step is using non-invasive “behavioral” treatments. If these steps are not successful in treating your symptoms, your provider may move on to other steps, such as medications, devices, or procedures.

Behavioral Treatments

Your healthcare provider may recommend changes in your lifestyle and behavior to treat UI, such as:

  • Managing foods and drinks. Avoiding alcohol, caffeine, and other beverages and foods that may contribute to UI can help improve bladder control. Avoiding any fluids between dinner and bedtime (other than sips of water for taking medications, if needed) may help reduce nighttime trips to the bathroom.
  • Losing weight may also improve bladder control in women if you are overweight and have stress or mixed incontinence.
  • Bladder training. This can help you better control urination by “training” the brain and bladder to hold back urination when you get a very urgent need to go. Bladder training starts with going to the bathroom on a regular schedule to help keep the bladder empty, and includes learning techniques to suppress strong urges. 
  • Pelvic floor muscle exercises (Kegel exercises). These exercises help strengthen the muscles that help support the bladder and urethra.  Many patients start with instructions from their healthcare provider. You might be referred to a specialized nurse or physical therapist to help make sure you are contracting the right muscles.

Medications

If behavioral approaches are not effective, your provider may recommend medication.  Several medications may be used to treat urge UI; currently there are no medications to treat stress UI.

  • Antimuscarinics. These medications decrease the need to urinate. However, these medications should be used with caution for older adults because they often cause dry mouth, dry eyes, constipation, and can increase the risk of confusion and falls, and long-term problems with memory. Common medications in this group are oxybutynin, tolterodine, fesoterodine, solifenacin, and darifenacin.
  • Mirabegron. This is a medication that also decreases the need to urinate by affecting different nerve receptors. It has different side effects than antimuscarinic medications. It can cause an increase in blood pressure and can interact with commonly used medications like metoprolol. 
  • Alpha-blockers and 5-alpha reductase inhibitors. These medications are often used to treat men with urinary symptoms due to an enlarged prostate. Alpha-blockers can cause a drop in blood pressure in some men.

Devices and Procedures

Sometimes, a device or intervention is needed to treat UI. Some of these include:

  • Pessarys. These are small devices inserted into the vagina for women who have a “dropped” or prolapsed bladder or uterus.  They work by supporting the bladder muscle and preventing urine leakage. There are different kinds of pessaries, so your healthcare provider or specialist will work with you to find the best fit. A pessary may or may not affect urinary leakage, depending on your situation.
  • Nerve stimulators. These devices are implanted under the skin like pacemakers. They send painless electrical pulses to spinal cord nerves that control the bladder muscle to treat urge incontinence.
  • Tibial nerve stimulation. For this device, a small electrode is placed on the skin above the ankle and used to stimulate a nerve to help with UI. This requires a number of sessions to get a full effect.
  • Botulinum toxin (“Botox”).  A urologist or urogynecologist will insert a tube into the bladder through the urethra and use a small needle to inject a small amount of botulinum toxin into the bladder muscle to help decrease unwanted contractions. The effect can last several months. Some patients may need to empty their bladder using a catheter for a while after the procedure.
  • Surgery. Depending on the type of UI someone has, there are several surgical procedures that may be performed if other treatments have not worked. Surgery is most commonly used for stress incontinence in women.

Last Updated November 2020