Treatment depends on the severity of the symptoms and how much they interfere with the person’s everyday life.
The doctor may also ask that you avoid caffeinated beverages and alcohol. Patients may be asked to keep a urinary diary, recording how many times you urinate during the day and night, and how often urinary leaking occurs. Download your personal urinary diary from this site or www.incostress.com
There are four major categories of treatment for stress incontinence:
- Behavioral changes
- Pelvic floor muscle training
Behavioral changes involve decreasing how many fluids you drink, if you drink an excessive amount during the day. (You should not decrease your fluid intake if you drink normal amounts of fluids.) Urinating more frequently may help some patients decrease the amount of urine that they leak. Constipation can make urinary incontinence worse, so dietary or medical treatments to help keep regular bowel habits are recommended. Weight loss has been shown to help decrease symptoms in those who are overweight. Some people with severe stress incontinence may change their activity level to avoid movements such as jumping or running, which can cause greater leakage of urine.Pelvic muscle training exercises (called Kegel exercises) may help control the leakage of urine. These exercises improve the strength and function of the urethral sphincter. Some women may use a device called a vaginal cone along with pelvic exercises, IncoStress is an ideal medical device to help. IncoStress is placed into the vagina, and the woman tries to contract the pelvic floor muscles in an effort to hold it in place. The device may be worn for up to 8 hours and is reusable. It has been recomended that pelvic floor exercises should be done at least twice a day. Within 4 to 6 weeks, about 70% of women have had some improvement in their symptoms.Biofeedback and electrical stimulation may be helpful for those who have trouble doing pelvic muscle training exercises. These two methods help a patient identify the correct muscle group to work. Biofeedback is method that helps a person learn how to control certain involuntary body responses. About 75% of patients who have used biofeedback for stress incontinence have said their symptoms got better; 15% were cured.Electrical stimulation therapy uses low-voltage electric current to stimulate and contract the correct group of muscles. The current is delivered using an anal or vaginal probe. The electrical stimulation therapy may be done at the doctor’s or physiotherapists facilities. Treatment sessions usually last 20 minutes and may be done every 1 to 4 days. Newer techniques are being investigated, including one that uses a specially designed electromagnetic chair that causes the pelvic floor muscles to contract when the patient is seated.Medicines are offered to patients with mild-to-moderate stress incontinence. They include:
- Antimuscarinic drugs block bladder contractions. Many doctors prescribe these types of drugs first.
- Alpha-adrenergic agonist drugs such as phenylpropanolamine and pseudoephedrine (common components of over-the-counter cold medications) help increase sphincter strength and improve symptoms in about 50% of patients.
- Imipramine, a tricyclic antidepressant, works in a similar way to alpha-adrenergic drugs.
Estrogen therapy can be used to improve urinary frequency, urgency and burning in postmenopausal women, and the tone and blood supply of the urethral sphincter muscles. However, whether estrogen treatment improves stress incontinence is controversial. Women with a history of breast or uterine cancer should usually not use estrogen therapy for the treatment of stress urinary incontinence.
Surgical treatment is only recommended after the exact cause of the urinary incontinence has been determined. Different types of surgeries are outlined in the heading Surgery in this blog.