Bladder Control

Stress Incontinence

Signs and Symptoms
Diagnosis
Treatment

Treatment

Behavioral therapies, pessaries (vaginal inserts) and surgery are the three treatment options for women with this condition. The objective is to rehabilitate the pelvic floor by building the strength and function of the muscles that support the bladder, urethra and other organs contained within the pelvic region.

• Behavioral treatments are simple, self-directed, have no side effects and are often used in conjunction with other treatment options. They have proven effective for many women and work well for certain types of incontinence. They include:
  
  1. Pelvic muscle exercises: Pelvic muscle exercises, also known as Kegels, can help improve incontinence and prevent it from worsening. They can help you suppress the urge to urinate. The exercises strengthen and tone the muscles that support the pelvic organs. These muscles contract and relax under your command to control the opening and closing of the bladder. When these muscles are weak, urine leakage may occur. To achieve the best results, imagine yourself as an athlete in training. You need to build strength AND endurance of your muscles. This requires commitment and regular exercise. Correct technique also is very important.
  2. Biofeedback: Biofeedback takes information about something happening in the body and presents it in a way that we can see or hear and understand. Getting on a scale to check your weight or having your blood pressure taken are very simple examples of biofeedback. Biofeedback can be used to measure any body response such as heart rate or muscle contraction and relaxation. The measurement can be displayed on a computer screen or heard as a tone and used to learn about a subtle body function.

     Biofeedback has been effective in treating urinary incontinence. It can help you learn to control and strengthen your pelvic floor muscles and play an important role in bladder control.

     Because you cannot see the pelvic floor muscles, you may find it difficult to locate them. Perhaps you are uncertain if you are doing the exercises correctly. This is where biofeedback can help. Biofeedback therapy uses computer graphs and audible tones to show you the muscles you are exercising. It also allows the therapist to measure your muscle strengthen and individualize your exercise program. It is a teaching tool to help you learn to control and strengthen the pelvic floor area.

• Vaginal inserts or pessaries are frequently used to treat bladder and pelvic support problems. A pessary is a vaginal insert, similar to a contraceptive diaphragm, which is placed into the vagina to support the uterus as well as bladder and rectum. It is a firm ring that presses against the wall of the vagina and urethra to help decrease leakage. The type and size of the insert is fitted to address your problem and your body. A properly fitted pessary is not noticeable when in place.
• Surgery is performed to restore the position of the bladder neck and urethra. There are two main types of surgical operations: bladder neck suspension procedures and sling procedures. Within the medical community, the comparative effectiveness of these procedures is still being debated, and it is important that your decision is based on your individual circumstance. If you are considering surgery, talk to your doctor about these factors.
  1. Bladder neck suspension procedures involve placing small stitches between the ligaments and tendons that support the pelvic organs and then tying them to the pubic bone to stabilize the bladder and urethra. These procedures can be performed through the vagina with a long needle or through an incision in the stomach. Vaginal bladder neck suspension procedures are performed more often since recovery time is shorter and other pelvic support problems (prolapsed organs) can be corrected at the same time.
  2. Pubovaginal sling procedures use a piece of strong connective tissue from another part of the body, typically from the abdomen, to create a supporting "hammock" underneath the urethra and bladder neck.
• Medications. There are currently no medications prescribed specifically for the treatment of stress urinary incontinence. However there are several experimental medications in development. We anticipate that medications for this condition will be available in the near future.

  Estrogen replacement therapy taken in pill or skin patch form has NOT been an effective treatment for female urinary incontinence. Vaginal estrogen (creams, vaginal rings or vaginal pellets) is useful for reducing recurrent urinary tract infections in postmenopausal women, but it's effectiveness in treating incontinence is not known.

Reviewed by health care specialists at UCSF Medical Center.
Last updated May 8, 2007