While urinary incontinence may be seen as a normal part of aging, sometimes, other conditions such as a vaginal infection, a urinary tract infection or constipation may also be the culprits.
The good news, according to the National Institutes of Health, is that there are more treatment options than ever before.
Noninvasive Treatments
Behavioral Modifications
Simple lifestyle or behavioral modifications are often the first therapy, and may be the only necessary treatment. These include modifying the diet, reducing liquids before bedtime, or eliminating or adding medications.
Behavioral therapy relies on biofeedback to increase the patient's awareness of the lower urinary tract, to strengthen the muscles that control the bladder. Pelvic floor muscle exercises, also known as Kegel exercises, strengthen the muscles around the urethra so that urine is less likely to leak, even under pressure. Over half of women who leak urine do so in part because they are unable to use these muscles to stop their leakage. For patients with difficulty identifying and strengthening their pelvic floor muscles, Mayo specialists use biofeedback and electrostimulation devices as training aids. These therapies require time, effort and commitment, but they do not have side effects and are often very effective.
Medications
Several medications treat incontinence by:
- preventing unwanted bladder contractions,
- tightening the bladder or urethra muscles, or
- relaxing bladder muscles.
Sometimes these drugs have unwanted side effects such as dry mouth, vision problems or urine buildup.
Minimally Invasive Treatments
Bulking agents
Bulking agents (space-filling substances) are used mainly to treat stress incontinence in men and women. Collagen and other materials can be injected into the tissue around the urethra to add bulk and keep the sphincter muscles closed to stop urine from leaking. A needle is inserted through the urethra and the bulking agent is injected into the area around the bladder neck to tighten it. Many patients see significant improvement in their condition following the injection. Most patients return to normal activity within a day or two following the procedure.
Collagen is one bulking agent used. A natural animal substance similar to fat, it begins to break down after several months, requiring repeat injections every four to 12 months. Newer substances, such as water-based gels, are also being used in the hope that they will provide longer-lasting results. Mayo physicians are also involved in a clinical trial of a newer bulking agent.
Botulinum toxin
Botulinum toxin (BOTOX®) is sometimes injected into the muscles of the bladder to treat incontinence. BOTOX® blocks the release of chemicals which cause muscle spasms. The injection is given under anesthesia and is effective for nine months to a year. It is not an FDA-approved treatment and is not usually covered by insurance.
Devices
Various devices can also be used to treat urinary incontinence. These options include:
- Pessary – a special device inserted in the vagina to hold up the bladder and prevent leakage
- Bladder neck support device – a prosthesis inserted in the vagina to elevate the bladder neck and restore the normal anatomic relationship between the bladder and urethra. This device is fitted by a physician and inserted and removed daily by the patient.
- Urethral insert – A small plug that is inserted into the urethra, and removed for urination.
- Urine seal – a small disposable foam pad that is placed over the urethra opening. This device is removed for urination and thrown away.
Surgical Treatment
When other options fail, surgery remains an excellent choice for treatment of urinary incontinence. It is often required to remove blockages, improve the bladder neck position, add permanent bulk to tissues or to add support to severely weakened pelvic muscles.