Stress Incontinence Treatments

Urinary incontinence affects approximately 25 million Americans each year. Within that group are people who suffer from stress incontinence, a specific type of incontinence that mostly affects women.

One-third of women over 45 suffer from this problem because it's often caused by experiences that weaken the urinary sphincter, such as childbirth and vaginal surgeries. While doctors often recommend wearing protective incontinence products as a temporary solution, there are many options for stress urinary incontinence treatment that can bring about long-lasting or even permanent relief.

What Is Stress Incontinence?

Stress incontinence is usually suspected when bladder leaks occur only during certain activities, including:

• Lifting
• Laughing
• Coughing
• Sneezing

Diagnosing Stress Incontinence

Diagnosis happens after your doctor has taken your medical history, completed a physical exam, taken a urine sample, and performed a number of tests, which may include a urinary stress test and urodynamics tests. Some medical providers may even ask you to start a bladder diary to keep a precise record of your bathroom habits.

Mild or Severe Stress Incontinence

Your doctor will determine whether your stress incontinence is mild or severe based on how much leakage you produce and how much it's affecting your everyday life.

Common Stress Incontinence Treatments for Mild Symptoms

Initial treatments for mild symptoms usually include noninvasive behavior modifications and therapies, such as:

• Avoiding activities that cause leaks
• Controlling fluid consumption
• Scheduling bathroom trips
• Training your bladder
• Practicing double voiding
• Making healthy lifestyle changes
• Avoiding consumption of bladder irritants
• Losing weight (if needed)

While these suggestions may be a starting point, they're often combined with other stress incontinence treatment options. Listed below are five of the most common female stress incontinence treatments.

#1 Pelvic Floor Strengtheners

Pelvic floor strengtheners help prevent leaks and suppress the urge to go and give you more control. Pelvic floor strengtheners are simple and can be used with other treatments.

Pelvic Floor Exercises

One of the most common methods for strengthening the pelvic floor is performing what is known as Kegel exercises. If you're not already familiar with Kegels, you can use these exercises to strengthen your urinary sphincter and pelvic floor muscles. 

To get started, just find the muscle you use to release urine when you use the bathroom. Practice starting and stopping your flow to become familiar with how it feels to contract this muscle. Once you know how to control it, you can tighten it at any time, even when you're not using the restroom.

Start by tightening the muscle for a count of five for 10 repetitions. Aim for doing this at least three times a day. Once that's comfortable, increase the time you contract the muscle up to a count of 10, or even higher. Talk to your doctor before trying Kegels or other pelvic floor exercises, as they aren't suitable for everyone.

The Knack

"The Knack" can be an effective method for using your pelvic floor muscles to squeeze your urethra shut before any leakage occurs. Your pelvic floor muscles automatically contract to keep the urethra closed when pressure hits the bladder. However, if your urethra doesn't respond fast enough, you'll experience a leak.

One study found that within one week of learning the Knack, participants leaked 98.2% less with a medium cough and 73.3% less with a deep cough. These individuals were taught to contract their pelvic floor muscles 1 second before they coughed. If you learn how to control your pelvic floor muscles at the right time by practicing this, you could avoid leaks naturally.

#2 Vaginal or Urethral Inserts

If pelvic floor strengtheners aren't making enough of a difference, your doctor may recommend a vaginal or urethral insert. 

Vaginal Inserts

Vaginal rings, or pessaries, are inserted into the vagina to press against the urethra. These medical-grade silicone or latex devices give the urethra that extra level of support it needs to help prevent chronic bladder leaks.

Ask your health-care provider if a pessary or vaginal ring would be right for you. They're typically fitted to your size to keep them in place regardless of your activity.

Urethral Inserts

A urethral insert is a tampon-like plug that you place inside your urethra when you want to block the release of urine in between bathroom trips. While many women find them uncomfortable, they may be useful for specific situations where you want to ensure you can avoid leaks.

#3 Electrical Stimulation

Pelvic floor electrical stimulation therapy works by sending an electric current through electrodes placed in the rectum or vagina. The current causes the pelvic floor muscles to contract to stimulate and strengthen them. This stress incontinence treatment is usually used with patients who haven't responded to other treatments.

#4 Medications

Currently, there are no medications specifically approved for treating stress incontinence in the United States, but you still have options. Doctors may prescribe medications designed for other purposes but have been found to help some patients, including Mirabegron (Myrbetriq), anticholinergics, and topical estrogen. In Europe, some medical providers prescribe the antidepressant Cymbalta to help control the contraction of the urinary sphincter.

#5 Surgery and Interventional Therapies

Although surgery is a last resort, procedures are available to improve the functioning of the sphincter or support the bladder neck.

Sling Procedure

Considered one of the most common surgeries for treating stress incontinence in women, the sling procedure involves using a mesh or a person's tissue to create a sling that supports the urethra. The goal of this procedure is to keep your urethra closed until you have to use the bathroom. There are three ways to do a mid-urethral sling:

• Retropubic method: A small cut is made inside your vagina along with two small incisions above the pubic bone that allow enough space to pull a needle through. The needle passes the sling under the urethra and behind the pubic bone.
• Single-incision mini: Only one incision is made inside of the vagina. Your surgeon pulls the sling through this one incision and places it under the urethra.
• Transobturator: This procedure is a lot like the retropubic method but without the incisions above the public bone. Instead, a surgeon makes a small opening on each side of the labia to pass the needle through.

Bladder Neck Suspension

The bladder neck suspension surgery is another way of adding support to the bladder neck and urethra. For this procedure, your surgeon makes an incision in your lower abdomen and secures stitches in the tissue near the bladder neck. This procedure requires a few weeks of recovery and possibly a urinary catheter.

Interventional Therapies

Additional nonsurgical therapies include:

• Bulking material injections to help keep the urethra closed
• OnabotulinumtoxinA (Botox) injections to aid in relaxing an overactive bladder

Find the Right Stress Incontinence Treatment for You

If you're one of the millions of women in the United States dealing with stress incontinence, you now have a few options. Start a bladder diary and document everything you think might be contributing to your incontinence. You can take it with you to your doctor's appointment and find the best stress incontinence treatment solution for your symptoms.