Urinary incontinence (UI) is the inability to control when you urinate. It is a common problem for women, but many avoid talking about it with their doctors. Why? According to the National Association for Continence (NAFC), the answer is: embarrassment.

Treating UI successfully requires finding the right treatment for your needs. You want a knowledgeable doctor whose expert opinion you trust. Rather than feeling embarrassed, you should be comfortable enough with your doctor to talk honestly about your issues and goals for treatment.

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How to Treat Urinary Incontinence

Because all women don’t experience UI the same way, the UPMC Urology Department offers a variety of treatment options. Your treatment depends on the kind of UI you have, your symptoms, and the severity. Treatments for UI include:

Dietary changes

  • Consume less caffeine and alcohol. Both have a diuretic effect that causes your body to produce more urine. Caffeine may also irritate your bladder and act as a stimulant. That can lead to undesired bladder contractions and urinary urgency.
  • Eat more fiber. Women who have chronic constipation place a lot of stress on the pelvic floor when they strain. Eating appropriate amounts of fiber can make bowel movements easier to pass. Less straining reduces the stress on your bladder.

Schedule changes

  • Make a bathroom schedule. Some women find it helpful to use the bathroom on a regular schedule. Called “bladder training,” this technique can help if you have an overactive bladder or trouble holding your urine. You set a schedule and gradually increase the amount of time between bathroom visits. Your doctor will give you very specific instructions about how to do this.
  • Avoid drinking before bedtime. This will help if you have to get up in the middle of the night to urinate. Be sure to get enough water during the day, but avoid drinking water or other beverages two to three hours before bedtime.

Kegel exercises

Kegel exercises can help both men and women. They are meant to strengthen the muscles in the pelvis and around the bladder, and they can be done anywhere. The Kegel exercise uses the same muscle you would use to stop the flow of urine. To do the exercise, squeeze that muscle and hold for several seconds, relax, then repeat several times in a row. Ideally, you should eventually be able to squeeze and hold for about 10 seconds. Building stronger pelvic floor muscles helps you get better at holding in urine.

Biofeedback

Biofeedback is a type of physical therapy. Biofeedback for UI uses special sensors to help you learn how to squeeze the pelvic floor muscles. The sensors tell you how much you are squeezing, so you can learn how to squeeze consistently. This technique helps you have better control of your bladder.

Pessary support

Your bladder is located very close to your vagina. If it is leaning on your vagina, your doctor may recommend a pessary, a small plastic device that is inserted into your vagina to support your bladder. Your doctor will help determine the best type of pessary for your needs. If your urethra (the tube that empties urine from your bladder) or urethral sphincter (the muscles that surround the urethra) are weak, the pessary helps by placing pressure on these areas from inside the vagina.

Injections

If your UI is caused by a weak urethral sphincter, you may benefit from an injection. Your doctor will inject a synthetic filler-type material into the sphincter to make it thicker. This helps hold the sphincter closed until you are ready to urinate. These injections may be done without surgery.

Surgery

If these treatments are not able to resolve your urinary incontinence, you may need to have surgery. These surgeries are used to treat UI in women:

  • Urethral sling: There are two types of sling procedures – midurethral and traditional. Both are designed to lift and support the urethra. In the midurethral sling, a surgeon uses a piece of mesh to support the urethra and bottom of the bladder. This is the most common type of sling surgery. It is usually done as a minimally invasive procedure through small incisions. A traditional sling procedure is more involved and has a longer recovery time. This surgery uses a strip of your own tissue (usually from your abdomen) to create a sling around the urethra.
  • Colposuspension: This is also called a Burch procedure. In this procedure, the surgeon uses stitches to attach the bottom of the bladder to nearby ligaments. This supports the bladder and urethra by attaching them in a normal position. This minimally invasive procedure is usually done on an outpatient basis.

Ask your primary care doctor for a referral to a UPMC urologist, or visit our website to schedule an appointment.

Sources

Urinary Incontinence in Older Adults. National Institute on Aging. Link

Why You Shouldn't Just Live With OAB. National Association for Continence. Link

Surgery for Stress Urinary Incontinence. The American College of Obstetricians and Gynecologists. Link

About Urology

The UPMC Department of Urology treats all manners of conditions involving the urinary tract and male reproductive organs. We treat those disorders both in children and adults. We have a multifaceted team of physicians and researchers working together to provide the best care. We provide cutting-edge treatments, and we continue to lead research into even better methods for diagnosis and treatment. U.S. News & World Report ranks UPMC Presbyterian Shadyside as among the best hospitals in the country for urological care.