Incontinence, urinary 

Treatment options for urinary incontinence 

Treatment
Pros
Cons

Useful links

 

 

Lifestyle changes

Drink less caffeine, drink 1.2 litres (six to eight glasses) of fluids every day, lose 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
  • Can improve urinary incontinence in men after surgery to remove the prostate gland
  • Can reduce urine leakage in women and improve quality of life
  • Exercise can 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 or stress incontinence
  • Requires training with a specialist
  • You need to continue training for at least six weeks

Medication

Duloxetine

Duloxetine can increase the muscle tone of the urethra, which should 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 recommended
  • May be easier to stick to than pelvic floor exercises or bladder training
  • Can be used alongside pelvic floor exercises for stress incontinence
  • Cannot be taken (or should be taken with caution) by:
    - elderly people
    - people with heart disease, uncontrolled high blood pressure, liver problems or kidney problems
    - women who are pregnant or breastfeeding
  • Can cause nausea or vomiting, indigestion, constipation, diarrhoea, hot flushes, headache, feeling agitated, difficulty sleeping
  • Can cause unpleasant symptoms when you stop taking it
Antimuscarinics

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

  • Can improve urge incontinence and overactive bladder syndrome (OAB)
  • Reduces the contractions that squeeze your bladder and cause an urge to go to the toilet, and increases the size of your bladder
  • Cannot be taken (or should be taken with caution) by:
    - elderly people
    - people with myasthenia gravis or ulcerative colitis
    - people with or at risk of glaucoma
  • Can cause constipation, flatulence, dry mouth, blurred vision, drowsiness, dry eyes
Desmopressin

Medicine that reduces the amount of urine you produce

  • Can improve nocturia, the frequent need to urinate at night
  • Reduces how many times you need to get up in the night and improves quality of sleep
  • Unlicensed for nocturia, meaning the manufacturers have not applied for a licence for this use

Surgery and procedures

Botox injections

Injections of botulinum toxin A into the side of the bladder

  • Can treat urge incontinence and overactive bladder syndrome (OAB)
  • Can cure or improve incontinence symptoms by 90%
  • Effects can last up to 12 months
  • Unlicensed for urge incontinence and OAB, meaning the medicine has not undergone clinical trials to see if it is effective and safe in the treatment of these conditions
  • Can affect your ability to pass urine and you may need a catheter (thin flexible tube) to drain urine from your bladder
  • Urinary tract infections are more common among people who use a catheter
  • Long-term effects are not yet known
Injecting bulking agents

A substance is injected into the walls of the urethra to help the urethra stay closed

  • 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 more injections
Fitting a sling around the bladder

Invasive surgery where a sling is inserted around the neck of the bladder to support it. Slings made from tissue taken from another part of your body are the most successful

  • Can be effective for stress incontinence
  • If a synthetic sling is used, this can cause problems later on such as difficulty urinating or urge incontinence
Fitting vaginal tape

Invasive surgery where a piece of 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
  • Can cause complications, such as damage to the bladder or urethra
Fitting an artificial bladder muscle

Invasive 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 cause complications, such as not being able to urinate
  • The pump that controls the sphincter may stop working
  • Sphincter often needs to be removed or fixed
Lifting and securing the bladder

Invasive surgery where the neck of the bladder is lifted upwards and stitched in place, known as colposuspension. Can be an open colposuspension (when surgery is carried out through a large incision) or a laparoscopic colposuspension (using a smaller incision)

  • Can be an effective long-term treatment for stress incontinence
  • Laparoscopic colposuspension needs to be carried out by an experienced laparoscopic surgeon, so there is limited availability
Nerve stimulation (through ankle)

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 improve symptoms of overactive bladder syndrome and sometimes cure this completely
  • 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 foot or toe pain, minor bleeding and headaches
  • Some people may find it too uncomfortable to continue with
Nerve stimulation (through spine)

Invasive 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
  • Two-thirds of women report an improvement in their symptoms or a cure
  • Can be painful and uncomfortable
  • Will require lifelong follow-up
Enlarging the bladder

Invasive surgery where the bladder is made larger by adding a piece of tissue from the bowel (known as augmentation cystoplasty)

  • Can be effective for urge incontinence
  • About half of women say their symptoms improve
  • Can affect your ability to pass urine and you may need a catheter (thin flexible tube) to drain urine from your bladder
  • Urinary tract infections are more common among people who use a catheter
  • You may need lifelong follow-up
Diverting urine flow

Invasive 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 is often 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
  • Urinary tract infections 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
  • Can be used if CIC does not work
  • Urinary tract infections are more common among people who use a catheter
Removing part of the prostate gland in men

A transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP) to remove part of the prostate gland. Other procedures are available, but are not recommended for general use by NICE

  • Can treat lower urinary tract symptoms (LUTS) caused by an enlarged prostate gland
  • Both techniques are effective at improving symptoms
  • TURP is the most established treatment
  • Will not work if your prostate gland is not causing your symptoms
  • Possible complications include difficulty passing urine, infection and ejaculation problems
  • HoLEP is not yet widely available

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Page last reviewed: 21/09/2012

Next review due: 21/09/2014