Urinary incontinence is the loss of urine or “bladder leak” when it is neither convenient nor socially acceptable. This leads to embarrassment, social isolation, and depression. It is more common than you think.
As many as 1 in 2 women and 1 in 4 men suffer from it. Since the risk factors associated with incontinence increases with age, many people consider this women’s’ issue or a normal part of aging. This is not the case. It is not uncommon for men to have issues. There are also many young women who suffer from bladder leakage.
The important point is that if you experience leakage, you do not have to accept this as a part of your reality. There are measures you can take to ease the discomfort or even resolve the issue.
7 Effective Ways To Treat Urinary Incontinence
Types Of Urinary Incontinence
To understand the treatment options, it is helpful to have a general understanding of the types of urinary incontinence that exists.
- Stress incontinence: Leakage with exertion of pressure. This is the kind of leakage people describe that occurs with laughing, sneezing, lifting, and exercising. It results from weakened muscles that support your bladder and urethra.
- Urge incontinence: Leakage that occurs with, well, urgency. People have the sudden desire to urinate and find it difficult to postpone it. This is when someone suddenly has to run to the bathroom everytime they hear water run, put their keys in the door, stand up from the cough, or other triggering behaviors. It results from minor issues like an overactive bladder to more severe issues like infection, nerve damage, or longstanding obstruction.
- Overflow incontinence: Leakage that tends to be more of a constant dribble. This occurs when the bladder has a hard time emptying and the urine overflows when it gets too full– like a pop off valve. This can happen as a result of conditions like diabetes or underlying neurological disorder.
- Mixed incontinence: You experience a combination of the above.
Fortunately, there are effective treatment options geared towards the type of leakage that you have. In general, they fall under these categories.
Changing the way you live day to day is one of the first things you should do. While this may not resolve your issues, a few changes may make you feel better.
- Diet: While there is not a scientific list of “bladder irritants” there are common foods that notably worsen symptoms. These include spicy foods, coffee, colas, teas. You can also read more about this here. Pay attention to how different foods affect you and your symptoms.
- Fluid management: Alcohol and caffeine cause you to make more urine, more quickly. Avoiding these beverages may improve your symptoms. Six to eight glasses of water in a day is ideal. Avoid drinking any fluids 2 hours before you go to bed if you want to sleep minimize getting up in the middle of the night.
- Bladder training: This is when you and your physician come up routine for emptying your bladder. This may involve timed voiding (going every set number of hours), scheduled voiding (going at specific times) and double voiding (voiding again after you think you are done). It may involve retraining your bladder to hold for ever longer periods of time. These methods can help both stress and urge related incontinence.
Pelvic Floor Physical Therapy
Strengthening the pelvic floor is beneficial for all kinds of leakage. For those with stress urinary incontinence, this targets the weak muscles that are the source of the problem.
For those with urge incontinence, the squeezing of the pelvic floor reflexively causes the bladder to quiet down,.
- Kegel exercises: These are the exercises that teach you how to tighten and relax the pelvic floor muscles and help to strengthen the urethral sphincter.
- Like with other areas of physical training, it takes commitment and training to learn how to do these exercises correctly. It is also important to continue these exercises if the results are to be maintained.
- Because the vast majority of people perform exercises incorrectly off the bat, it is very helpful to have a physical therapist guide your training.
These are mostly geared towards those with urgency and are highly effective. While there are medications for stress urinary incontinence under development, none of these are currently available.
- Anticholinergics – These medications target the bladder contractile receptors, causing the bladder to relax and hold more urine. Common names include oxybutynin, tolterodine, and trospium chloride. Side effects can include dry mouth, constipation, dry eyes, and more recently, has been associated long-term with dementia.
- Beta3 agonists – This is a newer family of medications, which include mirabegron. These also work to relax the bladder, but via a different mechanism. They have a cleaner side effect profile, but blood pressure needs to be monitored while on this medication.
- Hormone – Replacement of vaginal estrogen can improve the health of the vaginal walls. This in turn, improves the irritative symptoms and may ease symptoms of urgency.
For those with predominantly stress urinary incontinence, medications may not be helpful due to the anatomic disruptions. Internal devices may be able to recreate the lost support.
- Pessary – These are typically silicone based products that are fitted into the vagina that push up on the urethral wall. It essentially creates a speed bump to prevent leakage. Many patients have used menstrual cups or diaphragms for birth control and therefore may be familiar with the concept. These need to be regularly removed and cleaned.
- Impressa – Poise brand makes a tampon-like device that can be vaginally inserted. This works well for those without vaginal dryness.
- Clamp – For men, there are similar Cunningham Clamps or Pacey cuffs that work by pinching the penis off.
There are several options shy of major surgery that are very effective in the armatorium against leakage.
- Stress incontinence – A minimally invasive option is the application of urethral bulking agents. It does just that, bulks up the urethra. This creates more resistance to leakage and enhances the urethra’s natural closure mechanism.
- Urge incontinence – These are also aimed at relaxing the bladder, thereby increasing its capacity and forcing it to hold more. This works well for those with issues too severe for medications.
- Botox – Like the cosmetic cousin, this is a neurotoxin that is injected into the wall of the bladder. It lasts for 6-9 months on average.
- Percutaneous tibial nerve stimulation – A small electrode is placed at the ankle, sending a pulse to the nerves around the bladder to “calm down.” This is a weekly treatment for 12 weeks, followed by maintenance every month.
- Sacral nerve stimulation – like above, this aims to stimulate the pelvic plexus of nerves. It is like a bladder pacemaker and implanted under the skin. This is the only FDA approved treatment that can also help certain kinds of overflow incontinence.
When the minimally invasive options fail, there are several surgical options available. These range from slings, suspensions, artificial urinary sphincters, to bladder augmentations.
Due to the complexity of these procedures, it is important to have a thorough discussion of the expectations and outcomes with your physician.
External Collection Devices
Ultimately, there are certain underlying conditions that cannot be resolved completely. There are additional products that can mitigate the issues caused by urinary leakage.
- Catheters – These are tubes that can be used to drain the bladder. They can remain indwelling and connected to a drainage system, or they can also be used intermittently and removed once the urine has been evacuated.
- Collecting devices – There are condom catheters (men) and Purewick (women) catheters for women that can catch the urine outside the body.
- Absorbent products – Pads and diapers are highly effective in keeping a person dry. The downside is stigma associated with these products as well as the environmental hazard. To mitigate these concerns, there are now reusable, aesthetically appealing options. Check them out here.
Dr. Jessica Lubahn, MD is a medical doctor, specializing in urology.
She is a health writer and consultant. She is the founder of ONDRwear (ondrwear.com) which are luxe leak proof underwear, whose mission is to destigmatize urinary, menstrual and any other leakage through the creation of products that are both highly effective and beautiful.