Both non-surgical and surgical treatment options are available for urinary incontinence, depending on which form the patient is diagnosed with. Just as in vaginal prolapse, patients are given non-surgical and surgical options to choose from depending on the severity of their condition or wishes. With today’s minimally invasive surgeries, many more women are choosing to proceed with surgery since there is typically a one week period for recovery and the results are excellent.
Non-surgical treatment options include:
Kegel exercises
Kegel exercises strengthen the pelvic floor muscles. These exercies can help control stress urinary incontinence, urge urinary incontinence, overactive bladder, fecal incontinence and can help slow the progression of vaginal prolapse. Kegel exercises must be done correctly and regularly to work.
Pelvic floor therapy
Pelvic floor therapy consists of a series of visits to a physical therapist with specialized training in the treatment of pelvic floor problems. The physical therapist uses a combination of the techniques listed below depending on the type of urogynecological condition present.
Behavioral modification - education on diet, fluid intake and other lifestyle changes to manage various bothersome symptoms.
Bladder training - learning to use the pelvic floor muscles to suppress overactive bladder symptoms (urinary urgency, frequency, noturia and urge urinary incontinence).
Biofeedback - an intravaginal device used to train the pelvic floor muscles to contract or relax correctly.
Functional electrical stimulation - a device that can be used intravaginally or externally that delivers a gentle electrical current to activate or relax the nerves and muscles in the pelvis.
Manual therapy - pressure applied to and released from muscles in spasm to relax them and increase blood flow to the area for healing.
Joint and tissue mobilization - gentle manipulation to help calm the muscles and nerves of the pelvis.
Low-dose vaginal estrogen
Low-dose vaginal estrogen replaces declining estrogen in vaginal and urethral tissues easing symptoms of vaginal dryness, itching and irritation as well as urinary urgency, frequency and incontinence. Low-dose vaginal estrogen comes in a cream (Estrace™ or Premarin™), suppository (Vagifem™) or a ring (Estring™).
Vaginal pessary
A vaginal pessary is a removable, diaphragm-like device worn in the vagina to support vaginal prolapse and/or decrease stress urinary incontinence. There are a variety of types and sizes of pessaries available. A pessary fitting includes two or more office visits to find a type and size of pessary that will work for you.
Urethral insert
A urethral insert is a small disposable device worn in the urethra to temporarily block leakage of urine due to stress incontinence. The device is removed for urination.
Various overactive bladder medications
There are several brands of overactive bladder medications on the market to treat urge urinary incontinence. These medications work by relaxing the bladder muscle. Side effects are usually mild and include dry mouth, dry eyes, blurred vision, urinary retention, constipation, dizziness or drowsiness. Changing the brand or dose of medication can decrease side effects. The different brands of overactive bladder medications include:
- Detrol™
- Ditropan™
- Enablex™
- Oxytrol™
- Sanctura™
- Vesicare™
Surgical treatment options include:
Suburethral sling
A suburethral sling is a small strip of material that is inserted through an incision in the vagina and placed beneath the urethra. It provides a firm surface against which the urethra can be compressed during physical activity to prevent stress urinary incontinence. There are a variety of types of suburethral slings.
Tension-free Vaginal Tape™ (TVT)
The TVT is a brand of suburethral sling made of synthetic material that can be placed on an outpatient basis using local anesthesia. Click here for more information on TVT.
Urethral injections
A transurethral or periurethral injection is a simple outpatient procedure in which a substance is injected to narrow the urethra and prevent leakage. Click here for more information on urethral injections.
InterStim™ Therapy
InterStim™ Therapy is an FDA-approved treatment for urinary urgency, frequency, urge incontinence and retention. The InterStim™ is a small device that is implanted under the skin of one of the upper buttocks. It works by gently stimulating the sacral nerves to help the bladder function more normally. Click here for more information on InterStim™ Therapy.
BOTOX®
