Urinary Incontinence

Options Beyond Medicines? Tailor Your Treatment Plan

Reviewed by: Joanne Poje Tomasulo, M.D., ACOG

You’ve done it. You’ve taken the initiative and talked to your doctor. It might be your internist or gynecologist. What matters is that you spoke up. ”If you’re lucky enough to have a doctor or nurse practitioner that you trust and are comfortable with, start there,” said C. Seth Landefeld, M.D., chief of geriatrics at the University of California at San Francisco. “He or she may be able to take care of you, and if not, will know where to refer you.”

Your primary health care provider will likely perform some tests to try to determine the cause and type of your incontinence. There are four main types of urinary incontinence:

• Stress incontinence occurs when you leak urine occasionally after lifting a heavy object, exercising, coughing, or laughing.

• Urge incontinence, or overactive bladder, is an urgent need to pass urine and the inability to get to the toilet in time.

• Mixed incontinence is a combination of stress and urge, which is common.

• Overflow incontinence occurs when the bladder is too full for the bladder to hold urine.

Your doctor will give you a physical, take a medical history, and may do further tests to rule out neurological conditions, such as multiple sclerosis or the neurological complications of diabetes, that can affect bladder control. After reviewing your test results, your doctor will recommend some possible treatments:

• Pelvic floor exercises (“Kegels”). Targeted at strengthening your pelvic muscles, Kegels can help you regain control of your bladder. They are effective for women recovering from childbirth and people who have lost pelvic muscle tone with age. They are easy to do, but it’s important to learn them right, so your doctor may refer you to a physical therapist with training in these exercises. The training may be combined with biofeedback, which monitors contraction of bladder and pelvic muscles to help you learn to control these muscles faster.

• Bladder training. You follow a set plan for urinating at specific times before your bladder gets full, and then gradually increase the time between going as you retrain your bladder. “Some women are so afraid of leaking that they go to the bathroom every 15 minutes,” Roger Dmochowski, M.D., a professor of urologic surgery at Vanderbilt University in Nashville, Tennessee. “We try to extend the interval between urination.”

• Lifestyle changes. For some people, continence can be improved by losing weight or making dietary changes. Many people benefit from a weight loss of just 5 to 10 percent. Cutting back on sources of caffeine (coffee, soda, chocolate) and alcohol intake often improves you bladder control, too.

• Medications. A variety of medications are available by prescription to treat incontinence. If other therapies don’t work, then you may wish to discuss whether a medication is right for you. Be sure to ask about side effects and whether it will interfere with your current medications.

If these approaches don’t work, your doctor will probably refer you to a specialist, such as a:

• Urologist. These doctors specialize in treating diseases related to urination and the urinary tract in both men and women. (To learn more, visit the American Urological Foundation.

• Female urologist. They can be male or female, but “female urologists” undergo additional training in treating urological problems in women.

• Urogynecologist. Just as some urologists undergo special training in women’s issues, some gynecologists undergo special training in urology. They focus on women’s urinary and reproductive health. (To learn more, visit the American Urogynecologic Society.)

You may also see a urological nurse -- specially trained nurses who work with urologists, and are experienced in patient education, including pelvic floor exercises. If your primary care doctor hasn’t already referred you to a physical therapist trained in pelvic floor exercises, your specialist may. In many parts of the country, “continence programs” provide a kind of one-stop shopping: They provide a combination of specialists, physical therapists, nurses and other medical professionals in a single location.

Whichever of these specialists you see, he or she will be experienced in a variety of procedures that go beyond lifestyle changes, exercises and medicines. These include removable devices, which you remove when you need to urinate, and injectable substances that work like collagen to bulk up the urinary channel. Finally, several surgical options are effective, including placement of a “sling” around your urethra; the sling compresses the urethra and prevents leaks. Another surgical treatment involves implanting a sacral nerve stimulator. This device acts like a pacemaker for your bladder and allows you to control the nerve signals that cause urination.

Regardless of your treatment method, don’t turn your back on lifestyle approaches. “It’s good to combine these options with pelvic floor exercises, walking, losing weight, and other simple things,” said Dr. Landefeld. “Combining them with surgery makes the surgery more effective.”