Treatment for mixed incontinence can include combinations of therapies prescribed for either stress or urge related incontinence. These treatments are described below.
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:
Pelvic floor electrical stimulation uses low-grade electrical current to stimulate weak or inactive pelvic muscles to contract. A tampon-like sensor that connects to a handheld adjustable device is inserted in the vagina. The patient then increases the current to the level of a comfortable tingle. Regular electrical stimulation sessions can supplement or augment your pelvic muscle exercise regime. Units are available for home use and may be covered by medicare or insurers.
Normal voiding depends not only on the normal function of organs and muscles, but also on nerves that deliver appropriate signals regarding urination. In urge incontinence, the nerves regulating the bladder can become hyper-reactive, sending strong signals to empty before the bladder is full. Nerve stimulation therapies "jam" the pathways that transmit these abnormal messages.
In PTNS, a small acupuncture needle is placed in the ankle along the tibial nerve. A handheld device connects to the needle to deliver mild electrical impulses to the nerve. These travel up the tibial nerve to the sacral nerve plexus, which regulates the bladder. PTNS sessions are painless, last 30 minutes and are repeated weekly for 12 weeks. All sessions take place in a medical office.
Sacral neuromodulation therapy also uses electrical impules applied directly to the sacral nerves. Wires are threaded through openings in the pelvic bones along the sacral nerves. This is done in an operating room using local anesthesia. The wires are attached to a small external generator. If a two week test using the external device shows improvement in symptoms, a permanent device, called Interstim, is implanted under the skin. This procedure requires general anesthesia.
Botulinum toxin A, better known as botox, is used to treat patients with urge incontinence that does not improve with medications or other conservative therapies. It works by paralyzing bladder muscle, which helps decrease unwanted bladder contractions. Maximum relief is usually seen seven days after injection and normally lasts six to 12 months. Repeat injections are often needed.
Vaginal inserts and pessaries are frequently used to treat bladder and pelvic support problems. These devices are placed into the vagina to provide support for the uterus, bladder, urethra and rectum. A number of types are available, and the inserts are fit to meet your needs and anatomy.
Surgery is performed to restore the normal position of the bladder neck and urethra. There are two main types of operations for incontinence: 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 circumstances.
There are currently no medications marketed specifically for the treatment of stress urinary incontinence. However, there are several experimental medications in development. Medications for this condition should be available in the near future.
In urge incontinence or overactive bladder, medications can help relax the bladder. These medications do not cure incontinence, but they can be very useful in reducing or eliminating problems of bladder control. They can be used alone or in combination with behavioral treatments.
Estrogen replacement therapy taken in pill or skin patch form has not been shown to be an effective treatment for female urinary incontinence. Vaginal estrogen (creams, vaginal rings or vaginal pellets) have helped reduce recurrent urinary tract infections in postmenopausal women, but their effectiveness for incontinence is unknown.
Reviewed by health care specialists at UCSF Medical Center.