Bladder Control

Overactive Bladder or Urge Incontinence

Signs and Symptoms
Diagnosis
Treatment

Treatment

Behavioral therapies and medications are treatments for 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 treatments. They have been effective for many women with certain types of incontinence.
  

• 1. Bladder Training — Bladder training is an important form of behavior therapy that can be effective in treating urinary incontinence.

     The goals are to increase the interval between each time you urinate and to increase the amount of fluids your bladder can hold. This training can help diminish the sense of urgency and leakage.

     Bladder training requires that a fixed schedule be established, whether or not the urge to urinate is present. If urge occurs before the assigned interval, urge suppression techniques, such as relaxation and Kegel exercises, should be used. As success is achieved, the interval is lengthened in 15 to 30 minute increments until it is possible to remain comfortable for three or four hours. This goal can be adjusted to suit each woman's needs and desires.

     Keeping a diary of your bladder activity is very important. This helps your health care provider determine when to start the training and to monitor your progress throughout your program.

  2. Pelvic Muscle Exercises — Pelvic muscle exercises, also called Kegels, can help improve incontinence and prevent the condition 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 to control the opening and closing of the bladder. When these muscles are weak, urine leakage may occur. To achieve the best results, you need to build strength and endurance of your muscles. This requires commitment and regular exercise. Correct technique also is very important.
  3. 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 can't see the pelvic floor muscles, you may find it difficult to locate them. 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.

• Urge Suppression — Urge suppression is a way to help control the sudden urge to urinate so that going to the bathroom is not an emergency. Running to the bathroom is the worst thing you can do as it actually causes bladder irritability to increase and interfere with your ability to concentrate on controlling your bladder.

  When the urgency strikes, an "urge suppression" technique can help maintain control. Your goal is to maintain bladder control until you reach a toilet. A normally functioning bladder can wait until the appropriate opportunity to empty, an unstable bladder can not.

• Medications — Medications can help relax the bladder and provide relief from symptoms. They can be used alone or in combination with behavioral treatments. Since they are prescription drugs, they must be used under the supervision of a health care provider. Medications do not cure incontinence but can help reduce or eliminate problems of bladder control.

  Urge incontinence and overactive bladder are caused by involuntary bladder contractions. Certain medications called anticholinergic or antimuscarinics can block the chemicals that act on the bladder nerves and decrease bladder contractions. Many of these drugs are safe for long-term use. If you have glaucoma, you should check with your ophthalmologist. Tell your health care provider what other medications you are taking to avoid potential reactions with new medications.

  Estrogen replacement therapy taken in pill or skin patch form has not been effective treatment for female urinary incontinence. Vaginal estrogen (creams, vaginal rings or vaginal pellets) have helped reduce recurrent urinary tract infections in postmenopausal women. The effectiveness of these preparations for incontinence is not known.

Reviewed by health care specialists at UCSF Medical Center.
Last updated February 21, 2008