Treatment strategies differ depending on the cause of the incontinence :
1. Stress urinary incontinence
Non-surgical options may include :
• Bladder retraining and pelvic floor exercises.
These include Kegel exercises to strengthen the pelvic floor muscles that help hold in urine. If done correctly and diligently, it is able to improve the quality of life of at least 40-50 percent of women with SUI. The best results occur in the premenopausal age group, but older women can also benefit from this.
• Vaginal devices for stress incontinence.
Such as a ring pessary that presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage.
Surgical options may include :
• Collagen injections.
Bulking agents, such as collagen, are injected near the urinary sphincter. As the body may over time slowly eliminate certain bulking agents, repeat injections may be needed.
• Surgery for Stress Urinary Incontinence (SUI).
These are broadly classified into two categories :
a. Retropubic suspension
such as Burch colposuspension, where surgical threads called sutures are used to support the bladder neck.
b. Sling procedures
where slings of natural tissue or man-made mesh are used to support the bladder neck and urethra. The most common type in use today is tension-free vaginal tape (TVT).
2. Urge incontinence and overactive bladder
Treatment options include :
• Removal of the irritant. This includes reducing the amount of coffee and tea intake.
• Medication. The first line of treatment are drugs called anticholinergics that block the nerve signals causing frequent urination and urgency, and bladder spasms. The main dose-limiting problem is the side effect of mouth and throat dryness. If you have glaucoma, ask your doctor if these drugs are safe for you.
• Injections for overactive bladder. Those who are unable to tolerate anticholinergics may be offered injection of botulinum toxin A into the bladder wall. Botulinum toxin relaxes the bladder muscles, reducing its overactivity.
• Neuromodulation. The stimulation of the nerves to the bladder leaving the spine (neuromodulation) can be effective in some for whom urge incontinence does not respond to behavioural treatments or drugs. However, the therapy is expensive, involving surgery with possible surgical revisions and replacement.