Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Many people think incontinence cannot be treated at all or that surgery is the only way to treat incontinence. This is not true. Treatment options include behavioral, medical, and surgical therapies. Which treatment is best depends on the type and cause of the urinary incontinence. For urge incontinence, the emphasis is on finding and treating the underlying cause. For stress incontinence, surgery may be the most effective way to eliminate symptoms of incontinence. Medications may also improve symptoms of some types of incontinence.
Behavioral techniques are often the first treatment of choice because they are noninvasive and have no side effects.
Biofeedback: This involves retraining the bladder through pelvic muscle tightening and relaxing that is guided by a trained technologist.
Behavioral therapy: You may be able to change your habits to reduce or eliminate episodes of incontinence.
Timed voiding and bladder training: Keeping to a schedule for urinating may minimize your symptoms.
Pelvic-floor exercises: Kegel exercises help women strengthen muscles used during urination.
Pelvic-floor stimulation: Women can increase the tone of pelvic-floor muscles by having a small probe inserted into the vagina or rectum that delivers painless electrical pulses.
Weighted vaginal cone: For women, a cone-shaped weight is inserted into the vagina and exercises are performed to strengthen pelvic floor muscles.
Pessary: This device is inserted into a woman's vagina to support the bladder and improve bladder control.
Urethral plug: To block urine flow, a small tampon-like plug is inserted into the urethra.
In some cases, catheterization may be used to drain urine from the bladder. In this medical procedure, a thin tube is inserted into the urethra and bladder to drain urine. Several medications are also used to medically treat incontinence.
Anticholinergic or spasm-relieving drugs suppress bladder contraction and relax bladder muscles for those with urge incontinence or overactive bladder. These medications include darifenacin (Enablex), solifenacin (VESIcare), trospium (Sanctura, Sanctura XR), fesoterodine (Toviaz), topical oxybutynin (Gelnique), oral oxybutynin (Ditropan, Ditropan XL, Urotrol), tolterodine (Detrol, Detrol LA), and others.
Tricyclic antidepressants such as imipramine (Tofranil, Tofranil-PM) also have the above anticholinergic effects but are not approved for the use in patients with OAB.
Adrenergic agonists such as midodrine (ProAmatine) and pseudoephedrine (Sudafed) may increase internal sphincter tone in people with stress incontinence. These medications may have serious side effects, such as high blood pressure, and are therefore not commonly prescribed for stress incontinence.
Topical estrogen cream is sometimes prescribed to menopausal women to strengthen pelvic muscles and improve the health of vaginal tissues.
Surgery can correct an anatomical defect or alter bladder muscle function. All
surgeries need to be carefully discussed with your physician because of
potential complications and varying success rates and indications. Surgical
alter bladder neck position;
repair or support weakened pelvic floor muscles and improve leakage in a patient with stress incontinence;
remove a blockage;
implant a "sling" around the urethra (now done as an outpatient procedure in almost all cases);
implant a nerve stimulation device to increase awareness of need to urinate in patients with overactive bladder refractory to medications and behavioral treatments;
inject collagen around the urethra to add bulk to the area and compress the urethra, thus increasing resistance to urine flow;
enlarge the bladder by injecting an antispasmodic medication such as botulinum toxin type A (Botox, Botox Cosmetic) into the bladder muscle (used as an off-label approach to OAB that does not respond to other treatments).