Which treatment for stress incontinence is right for me?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Stress incontinence can be frustrating, inconvenient, and even embarrassing. If you find you are unable to control urine leakage when you sneeze, laugh, or exercise, you may need treatment. The best treatment depends on the cause of your incontinence and your personal preferences. Consider the following when making your decision:
- Incontinence can have more than one cause. The most significant cause is treated first, followed by treatment for secondary causes, if needed. The least invasive treatment methods are usually tried first.
- Mild to moderate stress incontinence may be effectively treated with exercise therapy, medications, or both.
- In up to 60% of women with stress incontinence, pelvic floor (Kegel) exercises can result in better control of the bladder when coughing, laughing, sneezing, or exercising.1
- Antidepressant medicine may be used, but its effectiveness varies.
- Surgery to add support for the bladder neck is usually needed for severe stress incontinence that does not respond to medication or exercise.
- Other options for the treatment of incontinence include mechanical devices called pessaries, intermittent self-catheterization (which is not used for stress incontinence), and absorbent pads or undergarments.
Medical Information
What is stress incontinence?
Stress incontinence is an involuntary release of urine that occurs when pressure is put on the abdomen during activities such as sneezing, laughing, or exercising. It is the most common type of urinary incontinence in women. Stress incontinence is caused by the bladder neck dropping too low in the pelvis (bladder drop), which may occur as a result of aging or having given birth several times. It is usually a long-lasting (chronic) problem that needs treatment.
What are pelvic floor (Kegel) exercises?
Kegel exercises, also called pelvic floor exercises, strengthen the pelvic muscles involved in urination. They can be performed any time during the day without anyone being aware you are doing them. During these exercises, you use the muscles that control urinary flow—tighten and hold them for 3 seconds, then relax them for 3 seconds. Do this 10 to 15 times per session. Try to do 3 or more sessions a day. Kegel exercises improve or cure urinary incontinence in many people who use them. By adding biofeedback—a relaxation technique for learning to control a body function that is not normally under conscious control, such as skin temperature or blood pressure—to Kegel exercises, the success rate for curing stress incontinence is even higher than with Kegel exercises alone.
What medications are used for stress incontinence?
There are two antidepressant medicines that are sometimes used to improve symptoms. But they do not cure stress incontinence.
Duloxetine is the one antidepressant that has shown promise for treating stress incontinence in women.2 Imipramine (such as Tofranil) is another antidepressant that is sometimes used to treat incontinence, although it is not usually effective for stress incontinence.
Can surgery help stress incontinence?
Surgery is used for severe stress incontinence or when other methods of treatment have failed. The decision to have surgery is based on an accurate diagnosis of the cause of the stress incontinence, other treatment possibilities, and realistic expectations for the surgery. Most surgical failures are due to incorrect diagnosis of the cause of the stress incontinence.
Surgery lifts and supports the connection between the bladder and the urethra. After surgery, you should have less or no urine leakage during activities that put pressure on the bladder, such as sneezing, coughing, and laughing.
What other treatments help reduce symptoms?
Absorbent products, certain mechanical devices (such as a catheter, pessary, or adhesive patch), or electrical stimulation are often used to treat urinary incontinence, before surgery. These methods have no serious side effects, can usually be done at home, and do not limit future treatment options. Most of these methods are successful in treating mild to moderate incontinence. Electrical stimulation is still being studied.
If you need more information, see the topic Urinary Incontinence in Women.
Your Information
Your choices are:
- Practice pelvic floor (Kegel) exercises to improve stress incontinence.
- Wear absorbent pads, try a mechanical device, or have electrical stimulation to try to reduce symptoms.
- Take medications to reduce stress incontinence.
- Have surgery for severe, uncontrolled stress incontinence once its cause is confirmed or for stress incontinence that is bad enough to compromise your quality of life.
The decision about which treatment to use for stress incontinence takes into account your personal feelings and the medical facts. The method you choose will depend on:
- The cause of the stress incontinence.
- Whether you have tried the least invasive treatments first.
- The severity and frequency of the stress incontinence.
- Other conditions that may affect your choice.
Deciding about treatments for stress incontinence Type of treatment Reasons to use treatment Reasons not to use treatment Pelvic floor (Kegel) exercises, absorbent pads, electrical stimulation, or mechanical device
- Kegel exercises reduce stress incontinence in 70% of women who do them.1
- These methods are the least invasive forms of treatment.
- You have tried Kegel exercises without success.
- Your incontinence is severe or is not controlled by these methods.
Medications
- Antidepressant medication can sometimes improve incontinence.
- Medications are not always effective.
- Medications may have side effects, such as sleepiness, dry mouth, blurred vision, and anxiety or agitation.
Surgery
- When the cause of stress incontinence is confirmed, surgery can often cure it.
- You have tried other less invasive means without success.
- Surgery is not always successful, especially if the cause of stress incontinence is misdiagnosed.
- Surgery is the most invasive treatment.
Are there other reasons you might want to choose one of these methods?
Are there other reasons you might not want to choose one of these methods?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about choosing treatment for stress incontinence. Discuss the worksheet with your health professional.
Circle the answer that best applies to you.
I have tried pelvic floor (Kegel) exercises for stress incontinence. Yes No NA* I don't mind wearing an absorbent pad when I exercise or perform other tasks that cause urinary leakage. Yes No Unsure I have no other health problems besides stress incontinence. Yes No Unsure The cause of my stress incontinence has been diagnosed and confirmed. Yes No Unsure I have tried Kegel exercises, but they have not helped. Yes No NA I have tried absorbent pads, Kegel exercises, and other-less invasive means, but they have not been successful. I would like to try medications now. Yes No NA I have tried medications and other treatments, but none have worked. Yes No NA My stress incontinence keeps me from enjoying social activities or exercising. Yes No NA My doctor has recommended surgery. Yes No NA *NA = Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to choose a particular treatment for stress incontinence.
Check the box below that represents your overall impression about your decision.
Leaning toward trying Kegel exercises or other methods to reduce symptoms
Leaning toward NOT trying Kegel exercises or other methods to reduce symptoms
Leaning toward trying medication
Leaning toward NOT trying medication
Leaning toward having surgery
Leaning toward NOT having surgery
Return to the topic Urinary Incontinence in Women.
| Author: | Kathe Gallagher, MSW | Last Updated: September 22, 2006 |
| Medical Review: | Martin Gabica, MD - Family Medicine Avery L. Seifert, MD - Urology | |
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