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Health A-Z

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Harvard Medical School

Treatment

Kegel Exercises
Many women can improve or eliminate urinary incontinence by doing pelvic muscle exercises. These are called Kegel exercises. They strengthen the muscles that surround the openings of the urethra, vagina and rectum.

To do Kegel exercises, squeeze your muscles to tighten your rectum and vagina. Hold Kegel squeezes for 6 to 8 seconds. Group 8 or 12 squeezes into each session. You can repeat these exercises several times each week.

Kegel exercises are particularly helpful for stress incontinence. They can also help control other types of incontinence. It can take several months or longer to see benefits.

Bladder Retraining
Urge incontinence can be improved by retraining. The goal is to help your bladder become less sensitive to its triggers over time.

The squeezing of your bladder is a conditioned response. You need to give your bladder a period of time when it is not stimulated by the signal of a full bladder. This helps your bladder to be less "jumpy."

To accomplish this, empty your bladder on a rigid schedule before it becomes full. You may need to urinate every half hour or hour. Gradually lengthen the interval between your bathroom stops. Your bladder may not respond as urgently after several weeks of retraining.

You also can improve urge incontinence by calming your bladder signals. Try not to race to the bathroom when you feel an urge to urinate. Instead, try sitting and breathing deeply for a short time. Or do Kegel exercises to distract your bladder.

Some specialists provide bladder sphincter biofeedback. This shows levels of bladder, rectum and abdominal pressure during Kegel squeezes or during relaxation techniques.

Medications
Several medications can improve symptoms of urge incontinence. The most commonly used medicines are oxybutynin (Ditropan) and tolterodine (Detrol).

Women who have a UTI are given antibiotics.

Some post-menopausal women have vaginitis caused by too little estrogen. Estrogen creams or tablets in the vagina can be helpful. Estrogen does not help urinary incontinence in women who do not have vaginitis.

Devices to Strengthen the Pelvic Muscles
Your doctor may recommend using cone-shaped weights. You place one of these cones into your vagina before you begin pelvic muscle exercises. These maximize the muscle-conditioning effect of Kegel exercises.

Pessaries
Urine leakage may be caused by a sagging uterus or a bulge or bend in the urethra. In these cases, a pessary may help. A pessary is a firm rubber ring that supports the bottom of your uterus. It can be inserted in the vagina by a physician and worn continuously.

Surgery
The most common cause of stress incontinence in women is lack of support at the bladder neck. Surgery can be used to treat this problem. It is usually considered when other treatments have been ineffective.

The goal of surgery is to wrap the urethra with a "sling" of fibrous tissue or loops of suture material. (The urethra is the drainage tube for the bladder.) The urethra is then tethered to the pelvis so it won't sag or shift off center.

Surgery can be done through an incision above the pubic bone or in the vagina. In some cases, a needle-shaped instrument is used. After pain-killing medicine is injected, the instrument is inserted through the skin above the pubic bone or the front wall of the vagina.

Some specialized medical centers use robotic surgery. Instruments attached to metal rods are inserted into the pelvis through small incisions. The instruments on the rods are maneuvered by a surgeon. The surgeon uses a remote control while watching a magnified video screen.

Occasionally, the bladder neck can be thickened by injecting a non-absorbable material. This can help some people to hold urine more easily.

Rarely, an electrical stimulator may be surgically implanted. This device periodically stimulates the nerve that controls bladder function and pelvic muscles. This may reduce symptoms in certain people who have urge incontinence or bladder overflow.

Other Strategies
If your urine leaks when you cough, seek treatment for your cough. If your cough results from smoking, talk to your doctor about ways to quit.

Pads or adult diapers can offer security. But they can also irritate the skin. They should not be the first or only treatment used for incontinence.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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