After your doctor figures out what type of incontinence you’re dealing with, it’s time to decide on a treatment plan. It will depend on what’s causing your leaking and how bad it is. Treating it can involve changes in your behavior, your medications, or sometimes even surgery.
Lifestyle or Behavioral Changes
If it’s right for your symptoms, your doctor may decide to try changes to your routine and diet first before moving on to medication or surgery.
Bladder training. If you have urgency incontinence (a constant “gotta go” feeling), your doctor may tell you to practice holding your urine for a short time when you get the urge instead of going right away. You can start by holding it for 10 minutes. After you successfully do that a few times, you can increase your time. You can also use set times during the day to go, and increase the time in between those regular bathroom trips. You can help your body learn to wait longer by practicing breathing or relaxation techniques.
Watching what you eat and drink. Treating your leaks may be as easy as avoiding certain foods and beverages. Your doctor may ask you to keep a bladder diary. This is a record of both your diet and your leaking episodes. Doing this may help you find out what’s triggering your leaks.
Double voiding. This is a technique you can use when you go to the bathroom to help your bladder empty out all the way. After you urinate, wait a minute or two, then try again immediately.
Pelvic floor exercises. Your pelvic floor is made up of a layer of muscles that stretch like a hammock from your pubic bone to your tailbone. They support your bladder and bowels. To strengthen these muscles, you can do Kegel exercises. These are exercises that involve tightening and holding the muscles that control your urine flow.
You can do them several times a day (not while urinating) to help build your pelvic muscle tone. If you’re having trouble doing Kegels, your doctor may recommend using biofeedback, or special sensors that can show you when you’re moving certain muscles.
There are many medications that can help get your bladder back to normal function. These include:
Antimuscarinics. These medications relax the muscles around your bladder to help them stop spasming. You can take them as a pill, a liquid, or use a patch. These medications include oxybutynin (Ditropan, Gelnique, Oxytrol), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), fesoterodine (Toviaz), and solifenacin (VESIcare).
Tricyclic antidepressants. Antidepressants reduce the signals coming from your nerves telling your bladder to spasm. An example is imipramine (Tofranil).
Alpha-blockers. These are best if you’re dealing with an enlarged prostate that is blocking your urine flow. They relax the smooth muscle around the prostate and bladder to help the urine get out. Examples include terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo).
5-alpha reductase inhibitors. These medications keep your body from making the hormones that make your prostate grow and get too big. By shrinking your prostate, they help urine get out when it needs to. Examples include finasteride (Proscar) and dutasteride (Avodart).
Beta-3 agonists. If your bladder is squeezing when it shouldn’t, your doctor may prescribe a beta-3 agonist. It keeps your bladder muscles from contracting. One example is mirabegron (Myrbetriq).
Botox. Your doctor can inject botulinum toxin type A, or botox, into your bladder to relax it. This helps it hold more urine. You can get the injection during an office visit. A botox treatment can last up to 10 months.
Your doctor will likely try other treatments before moving on to surgery. However, you might need surgery if:
- Your urinary incontinence is chronic or severe
- You have blood in your urine
- You have chronic urinary tract infections (UTIs)
- You have a blockage that a doctor needs to remove
Options for surgery include:
Sling procedures. This surgery involves taking either tissue from other parts of your body, or synthetic material or mesh, and making a sling around your urethra and the thick part of the muscle connecting the bladder to it (the bladder neck). This is helpful if you’re dealing with stress incontinence. The sling helps close your urethra when you put pressure on it -- like when you exercise, cough, or sneeze -- so urine won’t leak out.
Artificial urinary sphincter. An artificial sphincter (the muscle that opens and closes your bladder) is one option for treating urinary incontinence, if it’s caused by an enlarged prostate. A doctor puts a small, fluid-filled ring around your bladder neck. This helps keep your sphincter shut until it’s time for you to urinate. Once you have your artificial sphincter, you’ll have to press a valve under your skin when you go to the bathroom. This deflates it so urine can flow out of your bladder.
Prostate removal. If an enlarged prostate is causing your urinary incontinence, your doctor may decide to take it out.
Sacral nerve stimulation (SNS). Using an electric stimulator (similar to a pacemaker) under your skin, your doctor can zap your sacral nerve with electric pulses. This can help calm bladder spasms.
Urethral bulking. If your urethra has a hole that’s letting urine leak, your doctor can inject it with material (like collagen) that will build up the wall thickness and seal off extra openings. Your doctor uses a needle through the skin or directly into the urethra to do it. You may need general anesthesia during the procedure.
Catheter. When you can’t get all the urine out of your bladder on your own, your doctor may want you to use a catheter to help things along. A catheter is a soft, thin tube you insert into the tip of your penis. Your doctor may ask you to do this several times a day, or you may use a catheter that can stay in your urethra all the time.