First, the bad news: Urinary incontinence affects 13 million women in the United States, and surgical devices such as bladder slings, mesh implants and transvaginal tape have been shown to have high rates of complications.
Before we get to the good news, let’s back up a step. There are two types of urinary incontinence—stress incontinence and urgency incontinence.
Stress incontinence is when you are unable to “hold” urine when coughing, sneezing, exercising or lifting something. Many factors can cause the pelvic floor muscles to weaken, including (you guessed it) pregnancy, being overweight, getting older and having had a hysterectomy.
Urgency incontinence is when you have a strong urge to urinate and cannot make it to the bathroom before leaking or wetting occurs. The bladder may not be functioning properly because its nerves are damaged by various diseases, including diabetes, stroke or multiple sclerosis. In many cases, however, the cause of urgency incontinence cannot be found.
Now, the good news: There are many non-surgical treatment options for incontinence. And the treatments that have proved to be the most successful in achieving continence are free and easy to do—as shown by a 2012 report that reviewed 905 studies on urinary incontinence.
Let’s tackle stress incontinence first. The report showed that three out of 10 women experiencing stress incontinence achieved full control of their bladder, and an additional four out of 10 reduced their symptoms by pelvic floor muscle training alone, making it the most successful treatment studied. And the best way to train those muscles is with Kegel exercises. Invented by American gynecologist Dr. Arnold Kegel in the 1950s, the exercises work by strengthening the muscles of the pelvic floor.
Kegels are easy to do and can be done virtually anytime and anywhere—in the car, while watching TV or while working at your desk. Simply squeeze and hold the muscles you contract to stop yourself from going to the bathroom. Kegels should be done twice a day, and most women see results after six to 12 weeks. Kegel exercises have no side effects, but should not be done while urinating or with a full bladder as it might lead to a urinary tract infection.
Another way to strengthen the pelvic floor muscles is by electrical or magnetic stimulation. In electrical stimulation, a silicone rubber tube that is attached to a battery-operated unit is inserted into the vagina. A small amount of electricity is sent through the tube into the surrounding nerves causing the muscles to contract. According to a study done by the U.S. Department of Health & Human Services, two out of 10 women achieved continence using this method, while another two out of 10 saw improvement. Magnetic stimulation is a similar treatment, but has not been shown to be as effective. The treatments can be costly and time-consuming, but no adverse side effects have been reported.
Urgency incontinence is treated differently. The same study found that four out of 10 women improve their symptoms using bladder training, which involves building up the ability to hold urine for longer and longer periods by following a schedule, with the goal of urinating every three to four hours. The important thing is that, whether you feel the urge to urinate or not, you stick to the schedule.
Percutaneous tibial nerve stimulation is also used to treat urgency incontinence. A fine needle is inserted near the ankle, through which pulses of electricity are sent to travel through the tibial nerve up your leg and to your bladder muscle. Three out of 10 women show improvement of symptoms with this method, with no proven side effects, according to the U.S. Department of Health & Human Services study.
So what about prescription drugs? Studies have shown that low doses of vaginally administered estrogen may improve stress incontinence symptoms for some women, although there are health risks associated with hormone therapy. Cymbalta is an antidepressant that some doctors prescribe “off-label” for stress incontinence. Although some women did report improved bladder control, many women experienced side effects like dry mouth, nausea and fatigue and discontinued taking it.
Many drugs exist for treating urgency incontinence, including Enablex, Toviaz, Ditropan, Detrol and Sanctura. In general, about one in 10 women became continent using these medicines and an additional one to two showed improvement. An almost equal number, however, experienced side effects such as dry mouth, constipation and upset stomach.
Weight loss is another non-surgical urinary incontinence treatment. In one study, 388 overweight and obese women were assigned to an intensive six-month weight-loss program. About 75 percent of the women who lost weight noticed a significant reduction in weekly number of incontinence episodes. The benefits were greater for women suffering from stress incontinence than urgency incontinence, but both conditions showed improvement.
With so many tools available, urinary incontinence can almost always be improved without surgery. Do you suffer from incontinence? Schedule an appointment with one of our doctors today to learn more about your treatment options.