Incontinence is the involuntary loss of urine, gas, or feces. There are many types of incontinence, and you may experience more than one at the same time. Your treatment will depend on the cause and severity of the incontinence.
The following non-surgical techniques may be recommended by your provider:
- Bladder training, or urinating at scheduled times (instead of when you have an urge)
- Biofeedback, to show when pelvic exercises are being performed correctly
- Dietary changes, to avoid foods that trigger your symptoms
- Electrical stimulation that can change the nerve signals to the bladder and pelvic muscles
- Kegel or pelvic floor exercises to strengthen pelvic muscles
- Medications to improve bladder control
- A pessary, which is a device inserted into the vagina to help support the bladder, rectum, or uterus
In most cases, surgery for urinary incontinence is reserved for the treatment of stress urinary incontinence. If conservative treatment and medical management are not successful for urge urinary incontinence, there are some surgical treatment options.
Stress urinary incontinence treatments
Office procedures with urethral bulking agent: A cystoscope is placed in the urethra and bladder to inspect them. Then a needle is passed into the urethra. The bulking agent (calcium hydroxylapatite) is injected into two locations in the urethra to tighten the seal. It may take more than one injection to successfully achieve continence. Most insurance companies require bladder testing (urodynamic testing) prior to approval.
Retropubic suspension via open incision or laparoscopy: This is commonly called a “Burch procedure.” Sutures are placed at the outlet of the bladder. Then sutures are passed through ligaments in the pubic bone to stabilize the outlet of the bladder.
Slings with native tissue or mesh: A sling made of a synthetic polypropylene mesh can be placed at the outlet of the bladder. These slings are typically placed with two needles. The needles pass from a vaginal incision to two small incisions in the skin—behind the pubic bone (retropubic sling), or at the groin (transobturator sling). Slings can also be created from the layer of fascia above the pubic bone, or from the leg.
Urge urinary incontinence and overactive bladder treatments
- Office procedure with botulinum toxin injections in the bladder muscle: A cystoscope is placed in the urethra and bladder to inspect them and then a needle is passed into the bladder. The bladder muscle is injected at several locations with botulinum toxin to stop spasms.
- Office procedure with stimulation of the tibia nerve: The tibial nerve in the foot is stimulated via a needle weekly for 12 weeks. Some patients require monthly stimulation to continue to have an effect thereafter.
- Sacral nerve stimulation: A nerve stimulation therapy to treat an overactive bladder