Urinary Incontinence

Rebecca Rogers, MD

My prescription for urinary incontinence helped but I’m still having problems. What other options do I have? Lifestyle changes? Exercises? Surgery?

Not all incontinence is the same. The two most common types of urinary incontinence are stress incontinence and urge incontinence. Stress incontinence occurs with a cough, laugh or sneeze -- or any activity that increases pressure on the bladder. The problem in stress incontinence is that the urethra is not strong enough to hold in urine. Women with stress incontinence leak urine without an urge. They simply cough or sneeze and urine leaks.

This is in contrast to urge incontinence, which occurs when the bladder contracts uncontrollably. In this case, the problem lies in the bladder muscle; it squeezes urine out at inappropriate moments. Many women with urge incontinence also complain of frequency and nocturia (waking up frequently during the night to urinate). It is not uncommon for women with urge incontinence to void every hour and get up multiple times a night because of uncontrolled bladder contractions.

It is important to distinguish between the two types of incontinence because therapies vary, although the two types of incontinence do share some common treatments.

For urge incontinence, medications are commonly prescribed. The majority are anticholinergic, which work by making it more difficult for the bladder to contract. Unfortunately, they are also associated with many side effects, including constipation and dry mouth. Kegel exercises are also an effective treatment for women with urinary incontinence. When the pelvic muscles are contracted they send a message to the bladder muscle to relax.

This is a helpful strategy when women with urge incontinence are hit by the uncontrollable urge to void. Bladder retraining is also an effective treatment for urge incontinence. Since many women with urge incontinence are voiding as frequently as every half to one hour, bladder retraining places women on a voiding schedule rather than responding to every bladder contraction by running to the bathroom.

To do bladder retraining, women choose a voiding interval that they think they can comfortably wait. They then place themselves on a schedule of voiding, say every one hour for a few days. Once they are comfortable with that voiding interval, they increase the voiding interval by 15 to 30 minutes every few days, until they achieve a normal voiding interval of 2 to 4 hours.

Stress incontinence, on the other hand, is rarely treated by medications. Kegel exercises are an effective treatment for stress incontinence as well. These are performed by contracting the large muscles that make up the pelvic floor. Performing 30 to 40 Kegel exercises daily has been shown to improve continence in women with stress incontinence. Another option is the use of a pessary, a device inserted into the vagina like a tampon that increases urethral resistance. Since pessaries come in a variety of shapes and sizes, you must be fit for one by your doctor. Pessaries are made of silicone and need to be removed and cleaned on a regular basis. Most women can learn to care for their pessary themselves, although some women do need to have their doctor remove and clean their pessary for them.

Surgery is also a treatment option for women with stress incontinence. Although there are over 100 different anti-incontinence procedures described, only a few of them have proven effectiveness. The most commonly performed surgical procedures for stress incontinence include midurethral sling procedures, which weave a polypropylene mesh under the urethra to increase its support. Other options that may improve continence in women with stress or urge incontinence include weight loss and fluid management.

Rebecca Rogers, M.D.
Director, Division of Urogynecology
University of New Mexico Health Sciences Center
American Urogynecological Society
National Association for Continence