Incontinence Treatments

OVERACTIVE BLADDER/URGE INCONTINENCE TREATMENTS
Overactive bladder and urge incontinence (OAB/UI) are not treated surgically, although there are some medications available to help.  For long-term management, non-surgical approaches include lifestyle and dietary changes, bladder training, pelvic floor muscle exercises, and electrical stimulation.  

Pelvic floor muscle exercises have been shown to bring improvement not only for stress urinary incontinence, but also for urge incontinence and mixed incontinence.  The muscles of the pelvic floor hold the pelvic organs like a hammock.  With age and the loss of estrogen, lean body muscle tissue in general decreases, and the same is true of the pelvic floor muscles.  The aim of exercise is to alter the physiological responses of the bladder and pelvic floor so that they are strong enough to control the release of urine.  Your doctor may refer you to a physical therapist who specializes in pelvic floor therapy.

Electrical stimulation can be used to help return injured muscles to fitness, while biofeedback helps you learn strengthening treatments and exercises and record your progress.  Medical devices that block or capture urine are available, but many women find them difficult or uncomfortable to use.

Overall, non-surgical approaches have been found to provide noticeable improvement in symptoms in a majority of women.

STRESS URINARY INCONTINENCE TREATMENTS
Stress urinary incontinence or SUI treatment can involve both non-surgical and surgical options.  It is generally recommended that women try conservative approaches such as pelvic floor muscle exercises and lifestyle changes before opting for surgery.  In cases of mild to moderate SUI, these approaches may suffice.  There are no medications approved for the treatment of SUI in the United States.

Surgical approaches
For women with SUI or mixed incontinence, a variety of surgical techniques can be used to restore the urethra and bladder neck to their correct positions.

In retropubic colposuspension, the bladder neck and urethra are secured directly to bands of muscle running along the pubic bones.  This procedure can be performed either with open abdominal surgery (laparotomy) or with laparoscopic surgery, which requires only one or two small incisions over the pubic bone.  The laparoscopic technique offers the advantages of less pain and faster recovery. 

In sling procedures, a strip of tissue or a mesh implant is positioned under the urethra to hold it in a normal position and allow it to remain closed when appropriate.  Sling procedures have been shown to be effective for women with either severe or mild-to-moderate SUI, as well as in some cases of urge incontinence.   A comparison of retropubic colposuspension and the sling procedure found the highest success rates for women who had the sling procedure.  Overall, 86% of women who had the sling procedure reported they were satisfied with their treatment, compared to 78% of the women who had the retropubic colposuspension procedure. For information about surgical mesh, please click here to go to the Food and Drug Adminstration website.

In recent years there has been a transition to newer sling procedures that can be performed on an outpatient basis.  These are performed through the vagina and do not require abdominal incisions.

References
 

1. American Urological Association. Female Stress Urinary Incontinence Clinical Guidelines Panel: Report on the surgical management of female stress urinary incontinence. 1997. www.auanet.org/guidelines/main_reports/fsuimainrpt.pdf.
2. Dean NM, et al. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev. 2006;3:CD002239.
3. Lewin Group, Inc. Prevalence and treatment patterns of pelvic health disorders among U.S. women. National Women’s Health Resource Center 2007. www.healthywomen.org.4.  
4. Nilsson CG, et al. Seven-year follow-up of the Tension-Free Vaginal Tape procedure for treatment of urinary incontinence. J Am Coll Obstet Gynecol. 2004;6:1259-62.
5. Nygaard I, et al. Urinary incontinence in women. In: Litwin M, Saigal CS, eds. Urologic Diseases of America. 2007. pp.157-92.
6. Pesce F. Current management of stress urinary incontinence. BJU Int. 2004;94 Suppl 1:8-13.
7. Smith AL, et al. Modern management of women with stress urinary incontinence. Ostomy Wound Manage. 2004.;50(12):32-39.
8. University of Maryland Medical Center. Urinary incontinence. www.umm.edu/patiented

Reviewed: March 2008.