by Nicole Evans M.D.

Created on: August 07, 2009

There are several types of urinary incontinence. The most common types are stress incontinence, urge incontinence, overflow incontinence and mixed urgency and stress incontinence.

Treatment of Stress Urinary Incontinence

Kegel exercises that train the pelvic muscles and strengthen the pelvic floor are extremely effective for stress urinary incontinence. Biofeedback techniques and weighted vaginal cones may help the woman perform these exercises effectively. Kegel exercises must be continued for the improvement in stress incontinence to be maintained.

Urinary stress incontinence may also be treated with pessaries and continence tampons that can be placed vaginally to aid in urethral compression. Urethra plugs and caps can be placed and removed by the patient as well.

Surgical therapy can be effective in pelvic relaxation causing stress incontinence. The aim is to restore normal pelvic anatomy. There are many different surgical approaches and each woman will require an individual approach determined together with her surgeon. The surgery may be completed through the vagina, through the abdomen or through both.

Treatment of Urge Incontinence

Urge incontinence is also called Detrusor Overactivity. The detrusor is a muscle that causes the pressure within the bladder to elevate when it contracts. An overactive detrusor muscle has uninhibited contractions that increase bladder pressure, override the urethral pressure and cause the individual to leak urine.

If urge incontinence is occurring after bladder surgery or pelvic surgery with extensive bladder manipulation then these symptoms are usually transient and will resolve with time.

Otherwise, it may be helpful to keep a 3 day voiding diary. Asking the patient to keep track of when and what she drinks and how often and how much she voids (urinates) can provide insight into the cause. Urodynamic testing can then be done.

Bladder training with or without biofeedback therapy has been extremely successful in treating urge incontinence. This involves increasing the patient's bladder control and capacity by gradually increasing the amount of time between voids.

Medications may be useful for some individuals. These include ditropan (oxybutynin chloride), detrol (tolterodine tartrate), pro-banthine (propantheline bromide) and oxytrol (transdermal oxybutynin chloride) among others.

Treatment of Mixed Urgency and Stress Incontinence.

Unfortunately, research has yet to show which treatment offers the best outcomes for mixed incontinence. The physician should work with each patient on an individual patient to afford the best chance at symptom improvement in urinary incontinence.

Treatment of Overflow Incontinence

An individual with overflow incontinence has a bladder which has stretched to accommodate an increased volume of urine. The increased volume may be due to an outlet obstruction blocking the urethra. A common cause is prostatic hypertrophy in men.

In overflow incontinence the detrusor muscle has lost the ability to contract. Urine leaks out only after the bladder pressure exceeds the urethral pressure. The patient the leaks small amounts of urine.

Overflow incontinence is treated by identifying the underlying cause. Until this time self-catheterization to empty urine is required till the detrusor muscle is able to return to normal function.

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