Encouragingly, most continence problems can be successfully addressed by using non-surgical treatments and therapies. One study shows that only 8% of visits to a continence clinic resulted in surgery, meaning there are a number of other less invasive alternatives. During your treatment, you may learn about some or all of these.
Non-Invasive or Non-Surgical Treatments
Pelvic muscle exercises: These exercises help to strengthen the pelvic floor muscles, important to maintaining continence.
Biofeedback: This technique includes the use of electronic sensors, strategically placed to show how the pelvic floor muscles are contracting and relaxing. This helps patients to identify the correct muscles to use when doing Kegel, or pelvic muscle exercises.
Bladder training and urge suppression: This uses relaxation techniques, extending the intervals between trips to the bathroom, or going to the bathroom at scheduled times to improve continence.
Continence aids: These could include pads and protective garments to help manage urine loss, as well as catheters that help to drain the bladder, often used for overflow incontinence.
Medication: This includes anticholinergics, that calm an overactive bladder; topical estrogen to reduce symptoms, or tricyclic antidepressants to treat mixed incontinence.
Minimally invasive treatments generally include those that rely on entering the body through existing openings, or those that create a very small incision when compared to open or more invasive surgery.
Minimally Invasive Incontinence Treatments
Bulking injections: This uses materials such as collagen, carbon-coated zirconium beads or coaptite, which are injected into tissue surrounding the urethra to help keep the urethra closed and minimize urine leakage. The procedure is usually done in a doctor's office with local anesthesia for women (men may require general or regional anesthesia) and takes about five minutes. Repeat injections are usually needed every six to 18 months.
Electrical stimulation: A procedure during which electrodes are temporarily inserted into the rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but it can take several months and multiple treatments to be effective.
Invasive or surgical treatments generally include the types of surgeries that cannot be performed by less invasive means, such as endoscopy or laparoscopy.
Common Surgical Treatments
Bladder neck suspension: Intended provide support to the urethra and bladder neck, an area of thickened muscle where the bladder connects to the urethra. Because it involves an abdominal incision, it's usually done under general or regional anesthesia. The procedure usually takes an hour, with a six-week recovery period.
Pubovaginal slings: This and other sling procedures use synthetic material, mesh, or your own body's tissue to create a sling, or additional support, around the bladder neck and urethra, helping to keep the urethra closed. Slings are used to help when leakage occurs during coughing or sneezing.
Pelvic organ prolapse repairs: Reconstructive surgery designed to provide relief from pelvic discomfort. It requires general anesthesia and a hospital stay of one or two nights. During recovery, there is no heavy lifting for approximately six to 12 weeks.
Articifical urininary sphincter: A small device, helpful for men who have incontinence as a result of prostate cancer treatment or enlarged prostate. A fluid-filled ring is implanted around the neck of the bladder to prevent leakage. A valve under the skin is pressed to allow urination.