Treatment Options

What is the treatment for urinary incontinence?

Specific treatment for urinary incontinence will be determined by your doctor based on:

• The type of incontinence that you have
• The degree of bother from incontinence
• Your expectations from treatment
• Your tolerance or desire for specific medications, procedures, or therapies
• Associated medical conditions

Treatment may include:

Behavioral therapies to help you regain control of their bladder. These can help both stress and urgency incontinence include:

• Watch the type, quantity, and timing of food and drink that you take in
• Avoiding foods and beverages that are likely to cause incontinence
• Regular toileting to prevent the bladder from getting too full
• Weight Loss: Being overweight puts extra pressure on your bladder. Weight loss will relieve some of that pressure and will help you regain your bladder control.
• Urinate on a Schedule: Sometimes, the message that the bladder is full comes without warning and often too late. In these cases, women find that they lose urine on the way to the bathroom. There isn’t enough time between the message and their ability to get to the bathroom before they start to leak. Voiding on a schedule, also referred to as “Timed Voids” may help prevent these leaking episodes. It is exactly what it sounds like. You urinate on a schedule, sometimes even when you don’t feel like you have to so that you are not caught off guard.
• Completing a bladder diary helps to determine when you usually leak and what is a reasonable period of time between trips to the bathroom. Slowly, you can stretch the time between trips to the bathroom until you are voiding every 3 or 4 hours. Often times women find that keeping a bladder diary helps them be more consistent with their schedule.

Pelvic muscle rehabilitation (to improve pelvic muscle tone and prevent leakage). This can help both stress and urgency incontinence and include the following:

• Pelvic floor muscle exercises (PFME also called Kegel exercises). Regular, daily exercising of pelvic muscles can improve, and even cure urinary incontinence. At the Center for Women’s Pelvic Health at UCLA, our doctor can provide you with detailed written instructions and a written schedule for PFME’s.
• Pelvic floor muscle therapy (PFMT) is a comprehensive pelvic floor rehabilitation that is performed in conjunction with a trained professional, usually a physical therapist (PT). In addition to instruction in exercises, PT’s may incorporate other therapies such as electrical stimulation and biofeedback when necessary. 

Incontinence Devices

• Incontinence pessaries are reusable or disposable devices that can provide relief from the symptoms of incontinence.

Medication

• There are a number of oral medications that are effective in treating urgency incontinence. Your doctors can help advise you on which medications might be right for you based on your symptoms, other medical conditions, and medications that you are taking and the side effect profile of medications.

Minimally invasive procedures

• There are office-based procedures that can treat both stress incontinence and urgency incontinence. Injections for Incontinence or injection of material into the wall of the urethra can be an effective treatment for stress incontinence. Botox for Overactive Bladder into the bladder muscle is an effective treatment for urgency incontinence.

Surgery

• There are a number of different surgical procedures that can be done to treat urinary incontinence. Procedures are very different depending on whether stress incontinence or urgency incontinence is being treated.
• The most common surgery for stress incontinence is a sling procedure. There are different types of slings that can be performed depending on your condition and expectations. Minimally invasive synthetic or mesh mid urethral slings are extremely effective in treating many forms of stress incontinence and have become the gold standard for treating stress incontinence in women. These outpatient procedures have the advantage of a rapid recovery and a rapid return to normal activity. There are, however, some rare complications associated with mesh that patients need to be aware of. These include exposure of the mesh in the vagina, pain and displacement of the sling. An alternative to a mesh sling is one made from a patient’s own tissue. Fascia can be harvested from the abdominal wall or thigh and made into a sling. These types of slings avoid unique complications of mesh, but are longer procedures, with a longer recovery period, and a higher likelihood of post-surgical difficulty urinating.
• Other minimally invasive options including laparoscopic Burch surgery can also be performed to treat stress incontinence.
• At the Center for Women’s Pelvic Health at UCLA, our doctors have a vast experience in performing all surgical procedures for stress incontinence and can help you decide which is best for you.