The majority of incontinence conditions can be improved or cured with treatment, once the condition is brought to the attention of a health care professional and accurately diagnosed. Many women are too ashamed or embarrassed to discuss their incontinence condition with their health care team or think that treatment isn't available. In fact, a variety of treatment options are available for incontinence conditions, depending on which type of incontinence is diagnosed: stress incontinence, urge incontinence, overflow incontinence or mixed incontinence (check the Overview section of this topic for more information.)

Incontinence is not a disease, though it can be a symptom of an underlying condition, such as diabetes. However, most incontinence in women is triggered by problems with the bladder and sphincter muscles, which can weaken with age and from childbirth.

Treatment options include:

behavioral techniques
pelvic muscle exercises
medications
medical devices that block or capture urine
surgery to repair or lift the urethra or bladder neck to provide support

Your health care professional can teach you ways to control your bladder and sphincter muscles. Behavioral techniques generally are tried first, because once you learn them, you usually can do them yourself at home; they have no side effects and they don't preclude other treatment options. Types of behavioral techniques are:

Pelvic muscle exercises, known as Kegel exercises, strengthen the muscles that support the bladder, urethra, uterus and rectum, and are often used in stress incontinence therapy. The exercises involve squeezing the muscles, holding the squeeze for a few seconds, then relaxing, and repeating the process. Doing the exercises for 10 to 15 minutes two or three times a day and before activities that cause leakage improves urine control in 40 to 75 percent of women, according to the American College of Obstetricians and Gynecologists. Although unassisted Kegels don't require any equipment, assisted Kegels use cone-shaped weights that you use your vaginal muscles to hold in your vagina while standing. The keys to success with pelvic muscle exercises are accuracy-making sure you exercise the correct muscles, and compliance-sticking with the exercise program. Your health care professional can help you learn to identify the muscles. Sometimes biofeedback and electrical stimulation are used to improve exercise results.
Biofeedback is a training technique that teaches you how to control physical responses, such as breathing, muscle tension, heart rate and blood pressure that are not normally controlled voluntarily. Biofeedback techniques may help you to gain control over your bladder and pelvic muscles, and to strengthen the sphincter muscle. A monitoring device is placed on the muscles that let you know when you have contracted them, and how strong the contraction was. Over the years, mainstream health care professionals and insurers have increasingly accepted biofeedback techniques. The Health Care Financing Administration (HCFA, which is now the Centers for Medicare and Medicaid Services) announced on October 6, 2000 a new policy of mandated (required) Medicare coverage for biofeedback in the treatment of stress and/or urge incontinence in patients who failed a documented trial of pelvic muscle exercise training or who are unable to perform pelvic muscle exercises. For more information on biofeedback and its applications, see the "Biofeedback" health topic at this site.
Electrical stimulation: Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This procedure will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence. Some third-party payers refuse to pay for this procedure. However, on October 6, 2000, the HCFA announced mandatory national Medicare coverage for electrical stimulation for incontinence, but only as a secondary procedure.
Bladder training is used to treat urge incontinence, but may also be used for other types of incontinence. Your health care provider teaches different ways to control the urge to urinate, such as through distraction (thinking about things other than having to go to the bathroom). You also follow a urination schedule that gradually lengthens the time between bathroom visits. One study of this behavior modification therapy in women found 12 percent were cured of their incontinence and 75 percent saw improvement.

Several medications can be used to treat incontinence, and are sometimes used in conjunction with behavioral techniques. Because many drugs can have side effects, interact with other medications, or should not be used by people with certain medical conditions, only you and your health care professional can determine which medications are right for you.

Some of the medications are drugs that block production and use of a chemical that prompts bladder contractions. These medications are often used to treat urge incontinence, but they should not be taken by if you have urinary retention, stomach bloating, or narrow-angle glaucoma. The most common drugs for overactive bladder/urge incontinence are:

Oxybutynin (Ditropan XL) extended-release formula blocks bladder muscle contractions, and is recommended for treatment of urge incontinence. Common side effects include mouth, nose and throat dryness; drowsiness; constipation; nausea; and decreased sweating. Oxybutynin chloride can also produce blurred vision.
Tolterodine tartrate tablets (DETROL LA) is a once-daily drug for overactive bladder. Side effects include cause dry mouth, headaches, constipation, blurring of near vision, dizziness, drowsiness and abdominal pain.
Oxytrol patch. This is oxybutynin delivered through a patch that is applied two times a week. The most common side effect is skin irritation.
Two new drugs recently received FDA approval for treatment of overactive bladder. Trospium (Sanctura) and solifenacin (Vesicare) are designed to treat the symptoms of overactive bladder and are well-tolerated by patients.

There are currently no approved medications on the market to treat stress urinary incontinence but new medications are in clinical trials. One such drug is duloxetine (Cymbalta), which is actually an antidepressant that treats stress incontinence by stimulating the muscles at the opening of the bladder. Medications used to treat overactive bladder are not effective in treating the condition.

Estrogen therapy (applied vaginally in a cream, vaginal pill or ring) is believed to improve the normal functioning of muscles involved in urination, which may help symptoms caused by stress and mixed incontinence experienced by menopausal women. Vaginal applications of estrogen are also available as an estrogen-containing ring that is placed in the vagina.

Surgery

Surgical procedures also may help women with stress incontinence when less invasive therapies do not improve symptoms. Surgery is a serious step that needs to be discussed with your health care professional so you clearly understand all the risks, as well as the chances that the surgery will relieve your urine control and urinary tract support problems. Although the procedures do have high success rates, complications can occur, including recurrence of incontinence.

There are more than 100 surgical procedures for stress incontinence in women, and new techniques continue to emerge. Many surgical procedures seek to reposition the bladder neck or the bladder. They are done to correct stress incontinence that results when weakened support muscles allow the bladder, its "neck" where it joins the urethra, and the urethra to shift out of their normal position, or "drop," and prevent the sphincter from staying tight under pressure. The procedures can be performed via an incision in the abdomen, through the vagina, or both. They often involve raising the bladder or bladder neck and securing it with stitches to muscle, ligaments or bone. They require general anesthesia and a hospital stay, which may last up to five days, depending on the procedure and whether there are complications.

Some techniques use several small incisions for insertion of instruments and a laparoscope, a telescope that lets the surgeon see inside the abdomen and perform the procedure to raise the bladder or bladder neck. Recovery from laparoscopic procedures can be faster than from other procedures and less painful, but as with any surgery, there are risks.

For more severe cases of stress incontinence, a surgeon may use a piece of pelvic connective tissue, or a synthetic material to make a sling that holds the bladder up and also compresses the bottom of the bladder and the top of the urethra, preventing urine leaks. Sling operations are often performed in women who have had previous, unsuccessful surgery to correct incontinence.

In rare instances of stress incontinence, an artificial sphincter may be surgically implanted. A hollow, ring-shaped device that encircles the urethra is placed and filled with fluid that squeezes the urethra shut. A valve is also implanted under the skin that when pressed, deflates the device, permitting urination.

Surgery to remove tissue-causing blockage in the urinary tract, or to enlarge a small bladder, may also treat overflow incontinence.

One newly approved treatment option for stress incontinence is the Gynecare TVT Tension-free Support for Incontinence System, a minimally invasive procedure that can be performed in an outpatient setting.

The Gynecare TVT device uses a mesh sling to provide support to the middle of the urethra, the section that is strained during physical activities. This positioning of the device provides support only when needed and creates a "tension-free" treatment solution that reduces the risk of over-correcting. Long-term data show that four to six years after treatment, 85 percent of women treated with Gynecare TVT Tension-free Support remained dry and an additional 11 percent remained significantly improved, according to the manufacturer. While rare, there are risks with surgery, including injury to the bladder, bowel and blood vessels.

Other treatments for incontinence include:

A pessary is a device inserted by a health care professional into the vagina to support pelvic organs. It either presses against or supports the vagina wall and the urethra, leading to less urine leakage in stress incontinence. It has to be removed, cleaned and reinserted regularly to prevent possible urinary tract infections and vaginal ulcers. There are different kinds of pessaries, and you may have to try several different ones to obtain a good fit. Some patients may be able to remove and clean the pessary by themselves.
Bulking agents, which may be injected into tissues around the urethra to fatten them up to better support the urethra, and help the sphincter stay closed. Often, a natural protein substance called collagen, derived from the skin of cows, is used as the bulking material. Before you receive the injection, you have a skin test to make sure you are not allergic to the material. The collagen material can be implanted by a health care professional under local anesthesia in less than 30 minutes. Women with stress incontinence who have poor urethra function but good pelvic muscle support-and often who have had previous surgery for incontinence-are best suited for this treatment. The injections have to be repeated after a time because the body will gradually eliminate the collagen material. The Contigen Bard collagen implant has been used routinely for these cases since 1993 as a safe and effective treatment for sphincter malfunction. Other materials, such as Durasphere, are also available.
Catheters may be used either constantly or occasionally for overflow incontinence not caused by a blockage, or in women who cannot empty their bladders because of muscle weakness, previous surgery, or spinal cord injury. Your health care professional can teach you how to insert the catheter through the urethra into the bladder yourself so you can drain urine. When you use a catheter long-term, the tube will be connected to a urine collection bag that you can wear on your leg underneath clothing. You also need to be on the alert for urinary tract infections, which are possible with long-term catheter usage.
Sacral Nerve Stimulation: A new electronic stimulation therapy, comprising a surgically implanted sacral nerve stimulator, involves sending small, electrical impulses to the sacral nerve that controls voiding function. The continuous electrical stimulation reduces or eliminates urge incontinence. On June 29, 2001, the Centers for Medicare and Medicaid Services (CMS) expanded Medicare coverage to include a sacral nerve stimulation treatment for urinary incontinence and other voiding difficulties.
The Neocontrol Pelvic Floor Therapy System is a non-surgical, non-invasive procedure for the treatment of incontinence caused by pelvic floor weakness that uses extracorporeal magnetic innervation. The procedure requires the fully clothed patient to sit in a pulsating magnetic chair that stimulates the pelvic floor. A typical treatment session lasts approximately 20 minutes. Preliminary results from one uncontrolled trial suggest that extracorporeal magnetic innervation may have a place in the treatment of women with stress, urge or mixed urinary incontinence.

Pelvic Health Awareness: What's Going on Down There?

Learn more here about symptoms and treatment options for pelvic health conditions.

Treatment options include:

behavioral techniques
pelvic muscle exercises
medications
medical devices that block or capture urine
surgery to repair or lift the urethra or bladder neck to provide support

Pelvic muscle exercises, known as Kegel exercises, strengthen the muscles that support the bladder, urethra, uterus and rectum, and are often used in stress incontinence therapy. The exercises involve squeezing the muscles, holding the squeeze for a few seconds, then relaxing, and repeating the process. Doing the exercises for 15 10 to 15 minutes two or three times a day and before activities that cause leakage improves urine control in 40 to 75 percent of women, according to the American College of Obstetricians and Gynecologists. Although unassisted Kegels don't require any equipment, assisted Kegels use cone-shaped weights that you use your vaginal muscles to hold in your vagina while standing. The keys to success with pelvic muscle exercises are accuracy-making sure you exercise the correct muscles, and compliance-sticking with the exercise program. Your health care professional can help you learn to identify the muscles. Sometimes biofeedback and electrical stimulation are used to improve exercise results.
Biofeedback is a training technique that teaches you how to control physical responses, such as breathing, muscle tension, heart rate and blood pressure that are not normally controlled voluntarily. Biofeedback techniques may help you to gain control over your bladder and pelvic muscles, and to strengthen the sphincter muscle. A monitoring device is placed on the muscles that let you know when you have contracted them, and how strong the contraction was. Over the years, mainstream health care professionals and insurers have increasingly accepted biofeedback techniques. The Health Care Financing Administration (HCFA, which is now the Centers for Medicare and Medicaid Services) announced on October 6, 2000 a new policy of mandated (required) Medicare coverage for biofeedback in the treatment of stress and/or urge incontinence in patients who failed a documented trial of pelvic muscle exercise training or who are unable to perform pelvic muscle exercises. For more information on biofeedback and its applications, see the "Biofeedback" health topic at this site.
Electrical stimulation: Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This procedure will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence. Some third-party payers refuse to pay for this procedure. However, on October 6, 2000, the HCFA announced mandatory national Medicare coverage for electrical stimulation for incontinence, but only as a secondary procedure.
Bladder training is used to treat urge incontinence, but may also be used for other types of incontinence. Your health care provider teaches different ways to control the urge to urinate, such as through distraction (thinking about things other than having to go to the bathroom). You also follow a urination schedule that gradually lengthens the time between bathroom visits. One study of this behavior modification therapy in women found 12 percent were cured of their incontinence and 75 percent saw improvement.

Oxybutynin (Ditropan XL) extended-release formula blocks bladder muscle contractions, and is recommended for treatment of urge incontinence. Common side effects include mouth, nose and throat dryness; drowsiness; constipation; nausea; and decreased sweating. Oxybutynin chloride can also produce blurred vision.
Tolterodine tartrate tablets (DETROL LA) is a once-daily drug for overactive bladder. Side effects include cause dry mouth, headaches, constipation, blurring of near vision, dizziness, drowsiness and abdominal pain.
Oxytrol patch. This is oxybutynin delivered through a patch that is applied two times a week. The most common side effect is skin irritation.
Two new drugs recently received FDA approval for treatment of overactive bladder. Trospium (Sanctura) and solifenacin (Vesicare) are designed to treat the symptoms of overactive bladder and are well-tolerated by patients.

Surgery

Surgery to remove tissue-causing blockage in the urinary tract, or to enlarge a small bladder, may also treat overflow incontinence.

Other treatments for incontinence include:

A pessary is a device inserted by a health care professional into the vagina to support pelvic organs. It either presses against or supports the vagina wall and the urethra, leading to less urine leakage in stress incontinence. It has to be removed, cleaned and reinserted regularly to prevent possible urinary tract infections and vaginal ulcers. There are different kinds of pessaries, and you may have to try several different ones to obtain a good fit. Some patients may be able to remove and clean the pessary by themselves.
Bulking agents, which may be injected into tissues around the urethra to fatten them up to better support the urethra, and help the sphincter stay closed. Often, a natural protein substance called collagen, derived from the skin of cows, is used as the bulking material. Before you receive the injection, you have a skin test to make sure you are not allergic to the material. The collagen material can be implanted by a health care professional under local anesthesia in less than 30 minutes. Women with stress incontinence who have poor urethra function but good pelvic muscle support-and often who have had previous surgery for incontinence-are best suited for this treatment. The injections have to be repeated after a time because the body will gradually eliminate the collagen material. The Contigen Bard collagen implant has been used routinely for these cases since 1993 as a safe and effective treatment for sphincter malfunction. Other materials, such as Durasphere, are also available.
Catheters may be used either constantly or occasionally for overflow incontinence not caused by a blockage, or in women who cannot empty their bladders because of muscle weakness, previous surgery, or spinal cord injury. Your health care professional can teach you how to insert the catheter through the urethra into the bladder yourself so you can drain urine. When you use a catheter long-term, the tube will be connected to a urine collection bag that you can wear on your leg underneath clothing. You also need to be on the alert for urinary tract infections, which are possible with long-term catheter usage.
Sacral Nerve Stimulation: A new electronic stimulation therapy, comprising a surgically implanted sacral nerve stimulator, involves sending small, electrical impulses to the sacral nerve that controls voiding function. The continuous electrical stimulation reduces or eliminates urge incontinence. On June 29, 2001, the Centers for Medicare and Medicaid Services (CMS) expanded Medicare coverage to i