Health Center - Reproductive and Pelvic Health

No matter your age, the health of your reproductive and urinary organs—your pelvic organs—is important. If something goes wrong "down there," it affects your overall health and quality of life. Get answers to all of your most pressing questions and put an end to embarrassing symptoms.

Treating Stress Urinary Incontinence

woman talking to her doctorStress urinary incontinence (SUI) is diagnosed if you involuntarily release urine when you sneeze, cough, laugh or exert yourself.

Symptoms

Involuntary leaking of urine when you sneeze, laugh cough or exert yourself

Treatment Considerations

Treatment first involves identifying any underlying causes for the incontinence, such as a urinary tract infection or certain medications. Don't confuse incontinence with frequent urination, which also can have underlying causes, such as diabetes or taking in too much fluid. Treatments for incontinence include:

Lifestyle Options

  • Kegel exercises. Numerous studies find that consistently practicing these exercises strengthens the pelvic floor and reduces SUI. To do Kegels, pull in or squeeze your pelvic muscles as if you were trying to stop the flow of urine or keep from passing gas. Count to 10 as you hold the contraction, relax, then repeat. Aim for at least three sets of 10 contractions a day. Combining these exercises with pelvic floor therapy with a trained therapist, biofeedback, vaginal cones and/or electrical stimulation may be more effective than simply doing them on your own.
  • Weight loss. Losing weight relieves pressure on the bladder and pelvic floor, reducing the incidences of stress incontinence.
  • Dietary changes. This includes reducing or cutting out bladder irritants such as alcohol, caffeine, carbonated beverages, spicy food and citrus and limiting the overall amount of fluids you drink.

Medican Options

  • Imipramine. Low doses of this tricyclic antidepressant can help treat stress incontinence, although the drug is not approved for this use.
  • Pseudoephedrine. This medication, found in over-the-counter drugs like Sudafed, can also help with stress urinary incontinence. Again, it is not approved for this use, but your doctor can prescribe it "off label."
  • Duloxetine (Cymbalta). Another antidepressant, this drug is approved in Europe but not in the United States for treating stress incontinence. It treats stress incontinence by stimulating the muscles at the opening of the bladder. However, your doctor can prescribe it off label. One study that combined duloxetine with pelvic floor therapy found the two worked much better together than either alone, with incontinence episodes dropping 76 percent with the combined therapy.
  • Estrogen therapy. Applied vaginally in a cream, vaginal pill or ring, low-dose estrogen therapy helps improve the normal functioning of muscles involved in urination, which can help with stress incontinence.

Continence Devices

Special devices are available to help manage stress incontinence. They include external devices that "catch" and contain the urine; devices you insert into the vagina to support the bladder neck; and devices that are attached to the opening of the urethra or are inserted into the urethra. All require a doctor's prescription and training in how to use them.

Surgical Options