General Approach for Treating Specific Forms of Incontinence

Lifestyle measures, including dietary recommendations, bladder training and continent aids, are useful for anyone with incontinence. Other treatments vary depending on whether the patient has stress or urge incontinence. In people who have both, the treatment usually is aimed at the predominant form.

The general goal for women with stress incontinence is to strengthen the pelvic muscles. Typical steps for treating women with stress incontinence are:

• Devices and continent aids for blocking urine in the urethra (vaginal pessaries, adhesive pads, and others).
• Behavioral techniques and noninvasive devices, including Kegel exercises, weighted vaginal cones and biofeedback.
• Medications. Alpha-adrenergic agonists and anticholinergics are generally not effective in most cases.
• Surgery is a reasonable option if symptoms do not improve with noninvasive methods. There are many surgical techniques. Most are designed to restore the bladder neck and urethra to their anatomically correct positions.

The goal of most treatments for urge incontinence is to reduce the hyperactivity of the bladder. The following methods may be helpful:

• Behavioral methods
• Medications (anticholinergics and alpha blockers)
• Procedures that stimulate the pelvic floor or sacral nerves in the tailbone (Interstim), which help retrain the bladder