How To Manage Incontinence Without Surgery

Urinary incontinence (the loss of bladder control) is a common problem for many of my patients, but that doesn’t make it any less embarrassing for them. The severity of it can range from leaking urine when they cough or sneeze to having an urge to urinate that’s so sudden and strong that they often can’t get to a toilet in time. No matter where a person is along the spectrum of urinary incontinence, it’s not a pleasant condition. The good news is that for most people, simple lifestyle changes and/or medical treatment can ease the discomfort of incontinence, or even stop it altogether, without having to resort to surgery.

4 factors that increase your risk of developing urinary incontinence:

  1. Female gender. Women are more likely to have stress incontinence, due to pregnancy, childbirth, menopause and normal female anatomy. However, men with prostate gland problems are at increased risk of urge and overflow incontinence.

    Dr Weinberg

    Jerry Weinberg. MD

  2. Age. As you get older, the muscles in your bladder and urethra lose some of their strength. This reduces how much urine your bladder can hold and increase the chances of involuntary urine release.
  3. Being overweight. Extra weight increases pressure on your bladder and surrounding muscles, weakening them and allowing urine to leak out when you cough or sneeze.
  4. Other diseases. Neurological disease or diabetes may increase your risk of incontinence.

Are you experiencing any of these 5 types of urinary incontinence?

  1. Stress incontinence. Urine leaks when pressure is exerted on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
  2. Urge incontinence. You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as neurologic disorder or diabetes.
  3. Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.
  4. Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
  5. Mixed incontinence. You experience more than one type of urinary incontinence.

There are many treatments for incontinence that don’t involve surgery

Treatment for urinary incontinence depends on which type it is, its severity and the underlying cause. A combination of treatments may be needed. Your doctor, myself included, is likely to suggest the least invasive treatments first and move on to other options only if these techniques fail.

Behavioral techniques

  1. Bladder training. This is when you delay urination after you get the urge to go. (I.e., “holding it.”) Start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between trips to the toilet until you’re urinating only every two to four hours.
  2. Double voiding. This involves learning to empty your bladder more completely to avoid overflow incontinence. Double voiding means urinating, then waiting a few minutes and trying again.
  3. Scheduled toilet trips. Urinate every 2-4 hours rather than waiting for the need to go.
  4. Fluid and diet management. To control your bladder, you may need to avoid, or at least cut back on, alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity also can ease the problem.

Pelvic floor muscle exercises

Your doctor may recommend these exercises for you to do frequently to strengthen the muscles that help control urination. Also known as Kegel exercises, these techniques are especially effective for stress incontinence but may also help urge incontinence.

  • First, imagine that you’re trying to stop your urine flow. Then:
  • Tighten (contract) the muscles you would use to stop urinating and hold for 5 seconds, and then relax for 5 seconds. (If this is too hard, start by holding for 2 seconds and relaxing for 3 seconds.)
  • Work up to holding the contractions for 10 seconds at a time.
  • Aim for at least three sets of 10 repetitions each day.

To help you identify and contract the right muscles, you might want to work with a physical therapist or try biofeedback techniques.

Electrical stimulation

This method involves the temporary insertion of electrodes into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but you may need multiple treatments over several months.

Medications

Medications commonly used to treat incontinence include:

  1. Anticholinergics. These calm an overactive bladder and may be helpful for urge incontinence.
  2. Mirabegron (Myrbetriq). Used to treat urge incontinence, this medication relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It may also increase the amount you are able to urinate at one time, which helps empty your bladder more completely.
  3. Alpha blockers. In men with urge or overflow incontinence, these medications relax bladder neck muscles and muscle fibers in the prostate and make it easier to empty the bladder.
  4. Topical estrogen. Applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate tissues in the urethra and vaginal areas and reduce some of the symptoms of incontinence.

Medical devices

Devices designed to treat women with incontinence include:

  1. A urethral insert. A small, tampon-like disposable device is inserted into the urethra before a specific activity, such as tennis, that can trigger incontinence. The insert acts as a plug to prevent leakage and is removed before urination.
  2. A pessary. A stiff ring is inserted into the vagina and worn all day. This device helps hold up the bladder, which lies near the vagina, to prevent urine leakage, and may be recommended for incontinence due to a prolapsed bladder or uterus.

Absorbent pads and catheters

If these medical treatments do not completely eliminate incontinence, there are also these products you can try to help ease the discomfort and inconvenience of leaking urine:

  1. Pads and protective garments. These usually are no more bulky than normal underwear and can be easily worn under everyday clothing. Men who have problems with dribbles of urine can use a drip collector — a small pocket of absorbent padding worn over the penis and held in place by close-fitting underwear.
  2. Catheter. If you’re incontinent because your bladder doesn’t empty properly, your doctor may recommend that you insert a soft tube (catheter) into your urethra several times a day to drain your bladder. You can learn how to do this yourself, as well as how to clean the catheters for safe reuse.

Concerned about urinary incontinence? Please come see us.

If you are experiencing the embarrassment and inconvenience of urinary incontinence, please make an appointment with Westchester Health to see one of our urology specialists for an accurate diagnosis and immediate treatment. The sooner we can begin treatment, the faster you can control your bladder and enjoy life to the fullest. Whenever, wherever you need us, we’re here for you.

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By Jerry Weinberg, MD, a Urologist with Westchester Health, member of Westchester Health Physician Partners

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