Urinary incontinence - Non-surgical treatment 

Non-surgical treatments for urinary incontinence 

NHS continence services

NHS continence services are centres staffed by specialist nurses, sometimes called continence advisers, and specialist physiotherapists. They should be able to diagnose your condition and start treating you.

You can usually book an appointment without a referral from a GP. You can find more information about local services on the Bladder & Bowel Foundation’s website.

Urinary incontinence medicines information

Read more about the medicines used to treat urinary incontinence

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for urinary incontinence

The treatment you receive for urinary incontinence will depend on the type of incontinence you have and the severity of your symptoms. 

If your incontinence is caused by an underlying condition, such as an enlarged prostate gland in men, you will receive treatment for this first.

Conservative treatments, which do not involve medication or surgery, are tried first. These include:

  • lifestyle changes
  • pelvic floor muscle training
  • bladder training

After this, medication or surgery may be considered.

Read more about surgical treatments for urinary incontinence.

Incontinence products

There are several incontinence products that you might find useful for managing your urinary incontinence while you are waiting to be assessed or waiting for treatment to start.

Incontinence products include:

  • absorbent products, such as incontinence pants or pads 
  • hand-held urinals (urine collection bottles)
  • a catheter, a thin tube that is inserted into your bladder to drain urine
  • devices that are placed into the vagina or urethra to prevent urine leakage, for example while you exercise

For more information, see can I get incontinence products on the NHS?

Lifestyle changes

Your GP may suggest that you make some simple changes to your lifestyle to reduce your incontinence. These changes can help improve your condition, regardless of the type of urinary incontinence you have.

For example, your GP may recommend:

  • reducing your caffeine intake – caffeine is found in tea, coffee and cola and can increase the amount of urine your body produces
  • drinking 1-1.5 litres (six to eight glasses) of fluid a day – drinking too much or too little can cause symptoms that affect the lower urinary tract (bladder and urethra)
  • losing weight if you are overweight or obese – use the healthy weight calculator to find out if you are a healthy weight for your height

Pelvic floor muscle training

Your pelvic floor muscles are the muscles you use to control the flow of urine as you urinate. They surround the bladder and urethra (the tube that carries urine from the bladder to outside the body).

Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often one of the first treatments recommended.

Referral

Your GP may refer you to a specialist to start a programme of pelvic floor muscle training. Depending on what services are available in your area, you could be referred to:

  • a continence adviser – a specialist nurse at an NHS continence service
  • a urogynaecologist – a nurse who specialises in problems with the urinary system in women
  • a physiotherapist – a healthcare professional trained in using physical methods to promote healing
  • a specially trained practice nurse at your GP surgery

Your specialist will assess whether you are able to squeeze (contract) your pelvic floor muscles and by how much. If you can contract your pelvic floor muscles, you will be given an individual exercise programme based on your assessment. It should include: 

  • doing a minimum of eight muscle contractions at least three times a day
  • doing these exercises for at least three months
  • continuing with these exercises after three months if they are helping

Research suggests that women who complete pelvic floor muscle training experience fewer leaking episodes and report a better quality of life. Studies from around the world show that, with proper supervision, conservative treatment such as pelvic floor muscle training can improve stress or mixed urinary incontinence in women by two-thirds.

In men, some studies have shown that pelvic floor muscle training can reduce urinary incontinence particularly after surgery to remove the prostate gland.

Electrical stimulation

If you are unable to contract your pelvic floor muscles, using a device that measures and stimulates the electrical signals in the muscles may be recommended. This is called electrical stimulation.

A small probe will be inserted into the vagina in women or the anus in men. An electrical current runs through the probe, which helps to strengthen your pelvic floor muscles while you exercise them.

You may find electrical stimulation difficult or unpleasant to use, but it may be beneficial if you are unable to complete pelvic floor muscle contractions without it.

Biofeedback

Biofeedback is a way to monitor how well you are doing the pelvic floor exercises by giving you feedback as you do them. There are several different methods of biofeedback:

  • A small probe could be inserted into the vagina in women or the anus in men. This senses when the muscles are squeezed and feeds the information to a computer screen.
  • Electrodes (sticky electrical patches) could be attached to the skin of your abdomen or around the anus. These sense when the muscles are squeezed and feed the information to a computer screen.

Some research has found that biofeedback did not benefit women carrying out pelvic floor muscle training for urinary incontinence. However, the feedback may motivate some women.

For men, there is not much evidence to indicate whether biofeedback should be used. It may depend on what you and your specialist prefer, and what is available. 

If you wish to try biofeedback, talk to your specialist.

Vaginal cones

Vaginal cones may be used by women to assist with pelvic floor muscle training. Vaginal cones are small weights that are inserted into the vagina. You hold the weights in place using your pelvic floor muscles. When you can, you progress to the next vaginal cone, which weighs more.

Some women find vaginal cones uncomfortable or unpleasant to use, but they may help with stress or mixed urinary incontinence.

If you want to try using vaginal cones, speak to your specialist.

Bladder training

If you have been diagnosed with urge incontinence, one of the first treatments you may be offered is bladder training. Bladder training may also be combined with pelvic floor muscle training if you have stress or mixed urinary incontinence.

Bladder training involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. The course will usually last for at least six weeks.

If you have any problems with your memory, for example you have dementia, you may be given specific training to prevent leakages. This may involve a carer reminding you to go to the toilet at set times.

Medication for stress incontinence

If stress incontinence does not significantly improve after the measures outlined above, medication may be used.

Duloxetine is a possible medication for stress incontinence, although the National Institute for Health and Clinical Excellence (NICE) does not recommend duloxetine as an initial treatment for women with mainly stress incontinence.

Medication for stress incontinence aims to increase the muscle tone of the urethra, which should help keep it closed.

You will need to take duloxetine twice a day and will be assessed after two to four weeks to see if the medicine is beneficial or if it is causing any side effects.

Duloxetine should not be taken or should be used with caution by:

  • elderly people 
  • people with coronary heart disease
  • people with uncontrolled hypertension (high blood pressure) 
  • people with liver or kidney problems
  • women who are pregnant or breastfeeding

Your GP will discuss any other medical conditions you have to determine if you can take duloxetine.

Side effects

There are many possible side effects of duloxetine, including: 

Do not suddenly stop taking duloxetine as this can also cause unpleasant effects. Your GP will reduce your dose gradually if you are going to stop taking duloxetine.

For more information see our medicines information guide for urinary incontinence.

Medication for urge incontinence and overactive bladder syndrome

If bladder training is not an effective treatment for your urge incontinence, your GP may prescribe an antimuscarinic. Antimuscarinics may also be prescribed if you have overactive bladder syndrome (OAB), which is the frequent urge to urinate with or without urinary incontinence.

The first antimuscarinic that may be tried is called oxybutynin. There are two different types of oxybutynin tablets, and it is also available as a patch that you stick to your skin. If oxybutynin is not effective or unsuitable, other antimuscarinics that may be prescribed include:

  • darifenacin
  • fesoterodine
  • flavoxate 
  • propiverine
  • solifenacin
  • tolterodine
  • trospium

Your GP will usually start you at a low dose to minimise any possible side effects. The dose can then be increased until the medicine is effective.

You will be assessed after six weeks to see how you are getting on with the medication, and again after three to six months to see if you still need it.

Antimuscarinics should not be taken or should be used with caution by:

  • people with an untreated eye condition called angle closure glaucoma 
  • people with myasthenia gravis, a condition that causes some muscles around your body to become weak
  • people with severe ulcerative colitis, a long-term condition that affects the colon

Your GP will discuss any other medical conditions you have to determine which antimuscarinics are suitable for you.

Side effects

There are many possible side effects of antimuscarinics, including: 

  • dry mouth
  • constipation
  • indigestion and heartburn
  • blurred vision
  • dry eyes

For more information see our medicines information guide for urinary incontinence.

Medication for nocturia

A medication called desmopressin may be used to treat noctuira, which is the frequent need to get up during the night to urinate.

Another type of medication taken late in the afternoon, called a loop diuretic, may also prevent you from getting up in the night to pass urine. Diuretic medicine increases the production and flow of urine from your body. By removing excess fluid from your body in the afternoon, it may improve symptoms at night.

Desmopressin is licensed to treat bedwetting at night but is not licensed to treat nocturia. Loop diuretics are also not licensed to treat nocturia.

This means that the manufacturers of the medication have not applied for a license for their medication to be used in treating nocturia. In other words, the medication may not have undergone clinical trials (a type of research that tests one treatment against another) to see if it is effective and safe in the treatment of nocturia.

However, your GP or specialist may suggest an unlicensed medication if they think the medication is likely to be effective and the benefits of treatment outweigh any associated risk. 

If your GP is considering prescribing desmopressin or a loop diuretic, they should tell you that it is unlicensed and will discuss the possible risks and benefits with you.

Page last reviewed: 21/09/2012

Next review due: 21/09/2014

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