Treating Stress Urinary Incontinence

Stress urinary incontinence (SUI) is diagnosed if you involuntarily release urine when you sneeze, cough, laugh or exert yourself.

Symptoms

Involuntary leaking of urine when you sneeze, laugh cough or exert yourself

Treatment Considerations

Treatment first involves identifying any underlying causes for the incontinence, such as a urinary tract infection or certain medications. Don't confuse incontinence with frequent urination, which also can have underlying causes, such as diabetes or taking in too much fluid. Treatments for incontinence include:

Lifestyle Options

• Kegel exercises. Numerous studies find that consistently practicing these exercises strengthens the pelvic floor and reduces SUI. To do Kegels, pull in or squeeze your pelvic muscles as if you were trying to stop the flow of urine or keep from passing gas. Count to 10 as you hold the contraction, relax, then repeat. Aim for at least three sets of 10 contractions a day. Combining these exercises with pelvic floor therapy with a trained therapist, biofeedback, vaginal cones and/or electrical stimulation may be more effective than simply doing them on your own.
• Weight loss. Losing weight relieves pressure on the bladder and pelvic floor, reducing the incidences of stress incontinence.
• Dietary changes. This includes reducing or cutting out bladder irritants such as alcohol, caffeine, carbonated beverages, spicy food and citrus and limiting the overall amount of fluids you drink.

Medican Options

• Imipramine. Low doses of this tricyclic antidepressant can help treat stress incontinence, although the drug is not approved for this use.
• Pseudoephedrine. This medication, found in over-the-counter drugs like Sudafed, can also help with stress urinary incontinence. Again, it is not approved for this use, but your doctor can prescribe it "off label."
• Duloxetine (Cymbalta). Another antidepressant, this drug is approved in Europe but not in the United States for treating stress incontinence. It treats stress incontinence by stimulating the muscles at the opening of the bladder. However, your doctor can prescribe it off label. One study that combined duloxetine with pelvic floor therapy found the two worked much better together than either alone, with incontinence episodes dropping 76 percent with the combined therapy.
• Estrogen therapy. Applied vaginally in a cream, vaginal pill or ring, low-dose estrogen therapy helps improve the normal functioning of muscles involved in urination, which can help with stress incontinence.

Continence Devices

Special devices are available to help manage stress incontinence. They include external devices that "catch" and contain the urine; devices you insert into the vagina to support the bladder neck; and devices that are attached to the opening of the urethra or are inserted into the urethra. All require a doctor's prescription and training in how to use them.

Surgical Options

There are several commonly used surgeries for stress incontinence. The one that works best for you depends on your condition. The most common are:

• Colposuspension. These procedures can be performed laparoscopically (through a small opening in the abdomen), vaginally or through a traditional open procedure. The goal is to reposition the bladder neck or bladder if weakened support muscles under the bladder have caused the SUI. The surgery often involves raising the bladder or bladder neck and securing it with stitches to muscle, ligaments or bone. The surgery requires general anesthesia and a hospital stay of several days.
• Mid-urethral procedures. These procedures involve using a piece of pelvic connective tissue or a synthetic material to create a sling that supports the bladder and/or urethra to prevent leaks. While older procedures required a hospital stay and surgery under anesthesia, newer devices enable the procedure to be performed on an outpatient basis under local anesthesia with a short recovery and minimal scarring. The largest randomized clinical trial ever to compare one such procedure—using a sling to support the bladder—with the most commonly performed colposuspension procedure, called the Burch, found the sling procedure was more effective at improving SUI than the Burch procedure.
• Injectable bulking agents. With this treatment, natural substances such as collagen are injected into tissues around the urethra to "fatten" them up to better support the urethra and help the muscle that keeps the urethra closed stay closed. The collagen material can be implanted by a health care professional under local anesthesia in less than 30 minutes. The injections have to be repeated over time, however, because your body eventually eliminates the collagen material.

Questions to Ask Your Health Care Provider

1. What type of incontinence do I have?
2. Is an illness or disease I have causing my incontinence and will the leakage stop with treatment?
3. What tests should I have to determine the cause of my incontinence?
4. Could my prescription or over-the-counter medications be contributing to my incontinence?
5. Can my diet affect my bladder control?
6. Will losing weight help?
7. Can pelvic exercises help? How do I do them?
8. Are there any medications available? What are their benefits and side effects? Will they interact with any other prescriptions or over-the-counter medicines I'm taking?
9. Is menopause affecting my ability to control my urine? Will estrogen or hormone therapy help?
10. Can surgery solve my urine leakage problem?
11. What surgical procedure might help me, and what is its success rate?
12. What are the potential risks of the procedure, and what are possible complications after surgery?