Stress Incontinence in Women
Treatment

Behavioral therapies, vaginal inserts, electrical stimulation and surgery are the three treatment options for women with stress incontinence. 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

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 muscle exercises — Pelvic muscle exercises, also known as Kegels, are an essential part of improving incontinence and preventing it from worsening. They can also 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. Achieving results requires commitment and regular exercise. Correct technique is also very important.
• Biofeedback — Biofeedback has been proven effective in numerous research studies for the treatment of urinary incontinence. It can help you learn to control and strengthen your pelvic floor muscles, which play an important role in bladder control. Because you cannot see the pelvic floor muscles, you may find it difficult to locate them or to determine if you're doing pelvic muscle exercises correctly. 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 strength and individualize your exercise program.
• The knack — Normally, the pelvic floor muscles contract automatically when pressure hits the bladder, keeping the urethra sealed shut. But if your muscles do not contract quickly enough or with enough force, you may leak urine. The key to not leaking is to use your pelvic muscles just in time to squeeze the urethra shut. This well-timed muscle use is referred to as "the knack." Learning to use the pelvic muscles at the right time is a skill like learning any other new muscle activity. At first it might be hard, but with practice many can learn how to remain dry.

Vaginal Inserts

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.

Electrical Stimulation

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.

Surgery

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. If you are considering surgery, it is important that the decision be based on your individual circumstances.

Medications

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.

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.