Treatment depends on how bad your symptoms are and how they affect your life.
There are four main treatment approaches for urge incontinence:
- Bladder and pelvic floor muscle training
- Lifestyle changes
Managing urge incontinence most often begins with bladder retraining. This helps you become aware of when you lose urine because of bladder spasms. Then you relearn the skills you need to hold and release urine.
- You set a schedule of times when you should try to urinate. You try to avoid urination between these times.
- One method is to force yourself to wait 1 to 1 1/2 hours between trips to the bathroom, even if you have any leakage or an urge to urinate in between these times.
- As you become better at waiting, gradually increase the time by 1/2 hour until you are urinating every 3 to 4 hours.
PELVIC FLOOR MUSCLE TRAINING
Sometimes, Kegel exercises, biofeedback, or electrical stimulation may be used with bladder retraining. These methods help strengthen the muscles of your pelvic floor:
Kegel exercises. These are mainly used to treat people with stress incontinence. However, these exercises may also help relieve the symptoms of urge incontinence.
- You squeeze your pelvic floor muscles like you are trying to stop the flow of urine.
- Do this for 10 seconds, and then relax for 10 seconds.
- Repeat 10 times, three times a day.
Vaginal cones. This is a weighted cone that is inserted into the vagina to strengthen the pelvic floor muscles.
- You place the cone into the vagina.
- Then you try to squeeze your pelvic floor muscles to hold the cone in place.
- You can wear the cone for up to 15 minutes at a time, 2 times a day.
Biofeedback. This method can help you learn to identify and control your pelvic floor muscles.
- Some therapists place a sensor in the vagina (for women) or the anus (for men) so they can tell when they are squeezing the pelvic floor muscles.
- A monitor will display a graph showing which muscles are squeezing and which are at rest.
- The therapist can help you find the right muscles for performing Kegel exercises.
Electrical stimulation. This uses a gentle electrical current to contract your bladder muscles.
- The current is delivered using an anal or vaginal probe.
- This therapy may be done at the health care provider's office or at home.
- Treatment sessions usually last 20 minutes and may be done every 1 to 4 days.
Percutaneous tibial nerve stimulation (PTNS). This treatment may help some women with overactive bladder.
- An acupuncture needle is placed behind the ankle, and electrical stimulation is used for 30 minutes.
- Most often, treatments will occur weekly for around 12 weeks, and perhaps monthly after that.
Pay attention to how much water you drink and when you drink.
- Drinking enough water will help keep odors away.
- Drink a little bit of fluid at a time throughout the day, so your bladder does not need to handle a large amount of urine at one time. Drink less than 8 ounces (240 milliliters) at one time.
- Do not drink large amounts of fluids with meals.
- Sip small amounts of fluids between meals.
- Stop drinking fluids about 2 hours before bedtime.
- Avoid carbonated drinks.
It also may help to stop eating foods that may irritate the bladder, such as:
- Highly acidic foods, such as citrus fruits and juices
- Spicy foods
- Artificial sweeteners
Avoid activities that irritate the urethra and bladder. This includes taking bubble baths or using harsh soaps.
Medicines used to treat urge incontinence relax bladder contractions and help improve bladder function. There are several types of medicines that may be used alone or together:
- Anticholinergic medicines help relax the muscles of the bladder. They include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), and solifenacin (Vesicare).
- Beta agonist drugs can also help relax the muscles of the bladder. The only medicine of this type currently is mirabegron (Myrbetriq).
- Flavoxate (Urispas) is a drug that calms muscle spasms. However, studies have shown that it is not always effective at controlling symptoms of urge incontinence.
- Tricyclic antidepressants (imipramine, doxepin) help "paralyze" the smooth muscle of the bladder.
- Botox injections are commonly used to treat overactive bladder. The medicine is injected into the bladder through a cystoscope. The procedure is most often done in the health care provider's office.
These medicines may have side effects such as dizziness or dry mouth. Talk with your health care provider if you notice bothersome side effects.
If you have an infection, your health care provider will prescribe antibiotics. Be sure to take the entire amount as directed.
Surgery can help your bladder store more urine. It can also help relieve the pressure on your bladder. Surgery is only used for people who have too many spasms and are not able to store much urine.
Augmentation cystoplasty is the surgery most often performed for severe urge incontinence. In this surgery, a part of the bowel is added to the bladder. This increases the bladder size and allows it to store more urine.
Possible complications include:
There is a risk of forming tube-like passages from the bladder to other organs or your skin. These are called urinary fistulae. They can lead to:
- Urine draining out in an unusual way, such as from your vagina
- Urinary tract infection
- Difficulty urinating
Sacral nerve stimulation. A small unit is implanted under your skin. This sends small electrical pulses to the sacral nerve (one of the nerves that comes out at the base of your spine). The electrical pulses can be adjusted to help relieve your symptoms.
Urinary incontinence is a long-term (chronic) problem. While treatments can cure your condition, you should still to see your health care provider to make sure you are doing well and check for possible problems.