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Treatment of Incontinence, urinary

Stress incontinence

Pelvic floor exercises (also known Kegel exercises) are the best way to help strengthen the pelvic floor muscles. Your GP may refer you to a continence advisor or physiotherapist for advice. You can get vaginal cones (small, plastic, cone-shaped weights) that you hold inside your vagina to help you do pelvic floor muscle exercises. They are available from some pharmacies.

Some people may be referred for treatment with electric stimulators. These are used on your pelvic floor muscles to help increase their strength.

Some women find that addition oestrogen improves the strength and elasticity of their muscles, so HRT (hormone replacement therapy) may be a consideration.

In some cases, but only if other treatment has not worked, your GP may refer you for surgery. The surgical procedures used to treat stress incontinence include:

  • Colposuspension. This is an operation to lift your bladder neck. The surgeon makes a cut in your lower abdomen and puts stitches through the walls of the bladder neck. You will be in hospital for about a week. A laparoscopic colposuspension is the same procedure using keyhole surgery.
  • Bladder neck injections. Injections of collagen or another synthetic material are put into the wall of the urethra to strengthen it. It can be performed under local or general anaesthetic. Results will probably only last a few years and the procedure may need to be repeated.
  • Vaginal repair – this is surgery to lift the bladder neck. This procedure is usually only used on women who have had a prolapse (part of your vagina and bladder drop).
  • Bladder neck suspensions – this also raises the bladder neck, using stitches through the urethra and attached above the muscle in the abdominal wall.
  • Sling procedures - a sling is inserted to support the neck of the bladder and the urethra. If you have this procedure, you will be in hospital for about 5-6 days.  More recently, this technique has been performed using tension-free vaginal tape (TVT). This involves placing a U-shaped piece of synthetic tape underneath the urethra and stitching it to the abdominal wall. It can be done with local or general anesthetic. Recovery time is fairly quick. You can go home after 1-3 days and you can get back to your usual activities quite quickly. 

After surgery you will probably have to have a catheter in for a week or so. This is a thin tube that drains away your urine. Some women have problems emptying their bladders after surgery but usually this is only temporary. You may be advised to see a physiotherapist for a while. You should avoid any unnecessary exertion for at least three months.

Urge incontinence

The best way to improve urge incontinence may be to retrain the bladder. This is also known as 'bladder drill'. Over time, you can gradually stretch the bladder so that it can hold more urine. This means that you will have more time to get to the toilet after you feel the ‘urge’ and you are less likely to leak urine. Your doctor, nurse, or continence advisor (a nurse specially trained to help people with incontinence) will explain how to do bladder retraining.

There are drugs available to relax the bladder by blocking certain nerve impulses. These drugs are called anticholinergics and include oxybutynin, tolterodine, trospium chloride, and propiverine. They may have side effects such as a dry mouth, blurred vision and constipation so you should speak to your doctor about which one will suit you best.

If you have a bladder infection it may respond to treatment with antibiotics.

Often, a combination of drugs and bladder retraining is the best treatment. Surgery, or treatment with electric nerve stimulators, is occasionally used in the treatment of urge incontinence.

In the case of male overflow incontinence from prostate gland enlargement, the treatment is to relieve the outflow obstruction by an operation to remove part of the prostate.

Special incontinence clothing, pads and urine collecting devices are available. Some people use a device that literally stops urine leaking out: a penile sheath for men or a barrier device that acts like a tampon for women.  Call NHS Direct on 0845 4647 for details of your nearest continence service who can advise if you are eligible for free supplies.

You should make sure that getting to the toilet in a hurry is easy and perhaps consider having a commode in your bedroom.