Incontinence & Overactive Bladder Health Center

Stress incontinence can be frustrating, inconvenient, and even embarrassing. If you find you are unable to control urine leakage when you sneeze, laugh, or exercise, you may need treatment. The best treatment depends on the cause of your incontinence and your personal preferences. Consider the following when making your decision:

• Incontinence can have more than one cause. The most significant cause is treated first, followed by treatment for secondary causes, if needed. The least invasive treatment methods are usually tried first.
• Mild to moderate stress incontinence may be effectively treated with exercise therapy, medicines, or both.
• In up to 70% of women with stress incontinence, pelvic floor (Kegel) exercises can result in better control of the bladder when coughing, laughing, sneezing, or exercising.¹
• Antidepressant medicine may be used, but its effectiveness varies.
• Surgery to add support for the bladder neck is usually needed for severe stress incontinence that does not respond to medicine or exercise.
• Other options for the treatment of incontinence include mechanical devices called pessaries, intermittent self-catheterization (which is not used for stress incontinence), and absorbent pads or undergarments.

What is stress incontinence?

Stress incontinence is an involuntary release of urine that occurs when pressure is put on the abdomen during activities such as sneezing, laughing, or exercising. It is the most common type of urinary incontinence in women. Stress incontinence is caused by the bladder neck dropping too low in the pelvis (bladder drop), which may occur as a result of aging or having given birth several times. It is usually a long-lasting (chronic) problem that needs treatment.

What are pelvic floor (Kegel) exercises?

Kegel exercises, also called pelvic floor exercises, strengthen the pelvic muscles involved in urination. They can be performed any time during the day without anyone being aware you are doing them. During these exercises, you use the muscles that control urinary flow-tighten and hold them for 3 seconds, then relax them for 3 seconds. Do this 10 to 15 times each session. Try to do 3 or more sessions a day. Kegel exercises improve or cure urinary incontinence in many people who use them. By adding biofeedback-a relaxation technique for learning to control a body function that is not normally under conscious control, such as skin temperature or blood pressure-to Kegel exercises, the success rate for curing stress incontinence is even higher than with Kegel exercises alone.

What medicines are used for stress incontinence?

There are two antidepressant medicines that are sometimes used to improve symptoms. But they do not cure stress incontinence.

Duloxetine can help control stress incontinence. Studies show that duloxetine reduces the number of times women have stress incontinence.² Imipramine (such as Tofranil) is another antidepressant that is sometimes used to treat incontinence, although it is not usually effective for stress incontinence.

Can surgery help stress incontinence?

Surgery is used for severe stress incontinence or when other methods of treatment have failed. The decision to have surgery is based on an accurate diagnosis of the cause of the stress incontinence, other treatment possibilities, and realistic expectations for the surgery. Most surgical failures are due to incorrect diagnosis of the cause of the stress incontinence.

Surgery lifts and supports the connection between the bladder and the urethra. After surgery, you should have less or no urine leakage during activities that put pressure on the bladder, such as sneezing, coughing, and laughing.

What other treatments help reduce symptoms?

Absorbent products, certain mechanical devices (such as a catheter, pessary, or adhesive patch), or electrical stimulation are often used to treat urinary incontinence, before surgery. These methods have no serious side effects, can usually be done at home, and do not limit future treatment options. Most of these methods are successful in treating mild to moderate incontinence. Electrical stimulation is still being studied.

If you need more information, see the topic Urinary Incontinence in Women.

Your choices are:

• Practice pelvic floor (Kegel) exercises to improve stress incontinence.
• Wear absorbent pads, try a mechanical device, or have electrical stimulation to try to reduce symptoms.
• Take medicines to reduce stress incontinence.
• Have surgery for severe, uncontrolled stress incontinence after its cause is confirmed or for stress incontinence that is bad enough to compromise your quality of life.

The decision about which treatment to use for stress incontinence takes into account your personal feelings and the medical facts. The method you choose will depend on:

• The cause of the stress incontinence.
• Whether you have tried the least invasive treatments first.
• The severity and frequency of the stress incontinence.
• Other conditions that may affect your choice.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about choosing treatment for stress incontinence. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to choose a particular treatment for stress incontinence.

Check the box below that represents your overall impression about your decision.

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