Urinary incontinence - Treatment options 

Treatment options for urinary incontinence 

Treatment
Pros
Cons

Useful links

 

 

Lifestyle changes

Drinking less caffeine, altering how much fluid you drink each day, and losing weight if you need to

  • Can improve all types of urinary incontinence
  • May also improve your general health
  • None
Pelvic floor exercises

Exercising the pelvic floor muscles, which surround the bladder and control the flow of urine

  • Can improve stress and urge urinary incontinence in women
  • Can improve urinary incontinence in men after surgery to remove the prostate gland
  • Exercise may be helped with electrical stimulation, biofeedback or vaginal cones in women
  • Requires training with a specialist
  • You need to continue the exercises for at least three months
  • Some women may find electrical stimulation and vaginal cones uncomfortable or unpleasant to use
  • Not clear if biofeedback is beneficial or not
Bladder training

Learning techniques to increase the length of time between feeling the need to urinate and passing urine

  • Can improve urge and mixed incontinence
  • Can be combined with pelvic floor exercises for mixed incontinence
  • Requires training with a specialist
  • You need to continue training for at least six weeks
Incontinence products

Products and devices such as absorbent products and hand-held urinals

  • Can help prevent the accidental wetting of clothes
  • May be a useful way of managing incontinence while you are waiting to be assessed or waiting for treatment to take effect
  • Not usually a long-term solution for incontinence
  • Can't help treat the symptoms of incontinence

Medication

Duloxetine

Medication that can increase the muscle tone of the urethra, which can help keep it closed (the urethra is the tube that carries urine from the bladder to outside the body)

  • Can improve stress incontinence if above treatments do not work,
    and surgery is either not possible or not desired
  • Can be used alongside pelvic floor exercises for stress incontinence
  • Not suitable for everyone
  • Common side effects include nausea, dry mouth, fatigue and constipation
  • Can cause unpleasant symptoms if you stop taking it suddenly, so needs to be withdrawn gradually
Antimuscarinics

Medication, such as oxybutynin tablets, that affects the detrusor muscles in the wall of the bladder

  • Can improve urge incontinence and overactive bladder syndrome (OAB)
  • Available in form of skin patch as well as tablets and capsules
  • Not suitable for everyone
  • Common side effects include dry mouth, constipation, blurred vision and fatigue
  • In rare cases, can lead to glaucoma (build-up of pressure within the eye)
Mirabegron

Medication that causes the bladder muscle to relax, which helps the bladder fill up with and store urine

  • Can improve urge incontinence and overactive bladder syndrome (OAB)
  • An alternative to antimuscarinics if they are unsuitable for you, or you have tried them and they have not helped your urge incontinence or have caused unpleasant side effects
  • Not suitable for everyone
  • Common side effects include urinary tract infections (UTIs), a fast or irregular heartbeat, palpitations (suddenly noticeable heartbeats), a rash and itching
Desmopressin

Medication that reduces the amount of urine you produce

  • Can improve nocturia, the frequent need to urinate at night, and can improve quality of sleep
  • Doesn't usually cause many side effects
  • Not suitable for everyone
  • Unlicensed for nocturia, meaning the manufacturers have not applied for a licence for this use
  • Possible side effects can include headache, abdominal (tummy) pain and nausea

Surgery and procedures

Tape procedures 

Surgery where a piece of artificial tape is inserted to support the urethra (tube that carries urine from the bladder to outside the body)

  • Can be effective in women with stress incontinence
  • Problems that can occur afterwards include needing to go to the toilet more frequently and urgently, and being unable to completely empty the bladder
  • The tape can wear away or move over time and further surgery may be needed to adjust or remove it
  • Not suitable for men with urinary incontinence
Colposuspension

Surgery where the neck of the bladder is lifted upwards and stitched in place.

  • Can be effective in women with stress incontinence
  • 'Keyhole' colposuspension needs to be carried out by an experienced laparoscopic surgeon, so there is limited availability
  • Problems that can occur afterwards include difficulty emptying the bladder fully, recurrent UTIs and discomfort during sex
  • Not suitable for men with urinary incontinence
Sling procedures

Surgery where a sling is inserted around the neck of the bladder to support it

  • Can be effective for women with stress incontinence
  • Very occasionally used to treat men with stress incontinence
  • Problems that can occur afterwards include difficulty emptying the bladder fully when going to the toilet and the development of urge incontinence
  • Long-term effects of synthetic slings unknown
  • Only normally used in men as part of medical research
Urethral bulking agents

Substances injected into the walls of the urethra to increase its size and allow it to stay closed with more force

  • Can be effective for women with stress incontinence
  • Very occasionally used to treat men with stress incontinence
  • Less invasive than other types of surgery as no incisions are made
  • Less effective than surgery
  • Effectiveness of the bulking agents decreases over time
  • You may need repeated injections
  • Many people experience a slight burning sensation or bleeding when they pass urine for a short period afterwards
  • Only normally used in men as part of medical research
Artificial urinary sphincter

Surgery to fit an artificial sphincter (the ring of muscle that keeps urine in the bladder)

  • An option if another type of surgery has not been successful
  • Can be effective for men with stress incontinence
  • Many people experience bleeding and a burning sensation when they pass urine for a short period afterwards
  • The device may eventually stop working and may need to be removed during further surgery
  • You may need lifelong follow-up
Botox injections

Injections of botulinum toxin A into the side of the bladder

  • Can treat urge incontinence and overactive bladder syndrome (OAB)
  • Effect can last several months
  • Unlicensed for urge incontinence and OAB
  • Can affect your ability to pass urine and you may need a catheter (thin flexible tube) to drain urine from your bladder, which may also increase your risk of developing recurrent urinary tract infections (UTIs)
  • May need to be repeated to maintain the effect
  • Long-term effects are not yet known
Sacral nerve stimulation

Surgery where a device is inserted near the sacral nerves at the base of your back and an electric current is passed through the device to affect the other nerves in this area

  • Can be effective for urge incontinence caused by overactive bladder syndrome (OAB)
  • Can be painful and uncomfortable  
Tibial nerve stimulation

Where an electric current is passed through a needle in the posterior tibial nerve in the ankle, which stimulates the nerves around the bladder and pelvic floor

  • Can be effective for urge incontinence caused by overactive bladder syndrome (OAB)
  • Less invasive than most other procedures and types of surgery
  • Typically requires at least 12 weekly sessions lasting 30 minutes each
  • Effects do not last long after the sessions have stopped and more sessions may be needed
  • Can cause pain, minor bleeding and headaches
  • Not yet enough evidence to recommend as a routine treatment
Augmentation cystoplasty

 

Surgery where the bladder is made larger by adding a piece of tissue from the bowel

  • Can be effective for urge incontinence
  • Can affect your ability to pass urine and you may need a catheter (thin flexible tube) to drain urine from your bladder, which may also increase your risk of developing recurrent UTIs
  • You may need lifelong follow-up
Urinary diversion

Surgery where the tubes from the kidneys (ureters) are redirected to the outside of the body so urine is collected without flowing to the bladder first

  • Can be effective for urge incontinence
  • Can be considered if all other treatments have not been successful or are not suitable
  • Can cause complications such as bladder infections
  • Further surgery may be needed to correct any problems that occur
  • You may need lifelong follow-up
Clean intermittent catheterisation (CIC)

A catheter is inserted through your urethra and into your bladder to empty your bladder when you go to the toilet

  • Can be used for overflow incontinence
  • Can be used as many times a day as necessary
  • Using a catheter can feel a bit painful or uncomfortable at first, although any discomfort often subsides over time
  • UTIs are more common among people who use a catheter
  • You will need to be taught how to insert the catheter yourself
Indwelling catheterisation

As above but the catheter is left in place with a bag attached to collect the urine

  • Can be used for overflow incontinence if CIC does not work or is not suitable
  • Urinary tract infections are more common among people who use a catheter

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Page last reviewed: 06/10/2014

Next review due: 06/10/2016