Urinary incontinence is when a person cannot prevent urine from leaking out.It can be due to stress factors, such as coughing, it can happen during and after pregnancy, and it is more common with conditions such as obesity.The chances of it happening increase with age. Bladder control and pelvic floor, or Kegel, exercises can help prevent or reduce it.

Treatment

Treatment will depend on several factors, such as the type of incontinence, the patient’s age, general health, and their mental state.

Stress incontinence

Pelvic floor exercises, also known as Kegel exercises, help strengthen the urinary sphincter and pelvic floor muscles – the muscles that help control urination.

Bladder training

• Delaying the event: The aim is to control urge. The patient learns how to delay urination whenever there is an urge to do so.
• Double voiding: This involves urinating, then waiting for a couple of minutes, then urinating again.
• Toilet timetable: The person schedules bathroom at set times during the day, for example, every 2 hours.

Bladder training helps the patient gradually regain control over their bladder.

Medications for urinary incontinence

If medications are used, this is usually in combination with other techniques or exercises.

The following medications are prescribed to treat urinary incontinence:

• Anticholinergics calm overactive bladders and may help patients with urge incontinence.
• Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms.
• Imipramine (Tofranil) is a tricyclic antidepressant.

Medical devices

The following medical devices are designed for females.

• Urethral inserts: A woman inserts the device before activity and takes it out when she wants to urinate.
• Pessary: A rigid ring inserted into the vagina and worn all day. It helps hold the bladder up and prevent leakage.
• Radiofrequency therapy: Tissue in the lower urinary tract is heated. When it heals, it is usually firmer, often resulting in better urinary control.
• Botox (botulinum toxin type A): Injected into the bladder muscle, this can help those with an overactive bladder.
• Bulking agents: Injected into tissue around the urethra, these help keep the urethra closed.
• Sacral nerve stimulator: This is implanted under the skin of the buttock. A wire connects it to a nerve that runs from the spinal cord to the bladder. The wire emits an electrical pulse that stimulates the nerve, helping bladder control.

Surgery

Surgery is an option if other therapies do not work. Women who plan to have children should discuss surgical options with a doctor before making the decision.

• Sling procedures: A mesh is inserted under the neck of the bladder to help support the urethra and stop urine from leaking out.
• Colposuspension: Lifting the bladder neck can help relieve stress incontinence.
• Artificial sphincter: An artificial sphincter, or valve, may be inserted to control the flow of urine from the bladder into the urethra.

Other options

Urinary Catheter: A tube that goes from the bladder, through the urethra, out of the body into a bag which collects urine.

Absorbent pads: A wide range of absorbent pads is available at pharmacies and supermarkets.