Stepped Approach Treatment

Treatment of urinary incontinence depends on the type of incontinence a person has and their goals for improving their condition.

Treatment involves a “stepped approach” done in order. Your health care provider will:

1. Deal with medications, health problems, disabilities, or lifestyle factors that affect incontinence.
2. Teach behaviors that can help, such as timing when people drink fluids and use the toilet, and exercises to strengthen key muscles,
3. Using medications or devices, or doing surgery, if needed. Some of these medications can cause cognitive impairment (problems with thinking and memory).
4. Referral to a specialist for people especially with severe pain, major pelvic problems, and other conditions.

Lifestyle and Behavior Changes

Your healthcare provider may recommend changes in your lifestyle and behavior to treat UI, such as:

• Managing foods and drinks. Avoiding foods and drinks that can cause incontinence may help. Avoiding fluids after dinner may help reduce nighttime trips to the bathroom.
• Losing weight may improve bladder control.
• Bladder training. This involves training the brain and bladder to hold back urine when the person gets a very urgent need to go.  
• Pelvic floor muscle exercises (Kegel exercises). These exercises help strengthen the muscles that help support the bladder and urethra.

Medications, Devices, and Procedures

Medication

If behavioral approaches are not effective, your provider may recommend medication.  Several medications may be used to treat urge incontinence. However, they can have serious side effects. No medications are available to treat stress incontinence.

• Antimuscarinics (such as Oxybutynin). These medications decrease the need to urinate. However, in older adults they often cause dry mouth, dry eyes, and constipation. These drugs also can increase the risk of confusion and falls, and long-term problems with memory.
• Mirabegron. This is a medication that decreases the need to urinate by affecting different nerves. This drug can increase blood pressure and can affect some common medications. 
• Alpha-blockers (such as Terazosin) and 5-alpha reductase inhibitors (such as finasteride). These medications are often used to treat men with urinary symptoms due to an enlarged prostate. Alpha-blockers can cause a drop in blood pressure for some men.

Devices or Procedures

Sometimes, a device or procedure is needed to treat UI. Some of these include:

• Pessarys. These are small devices inserted into the vagina for women who have a “dropped” or prolapsed bladder or uterus. 
• Nerve stimulators. These devices send painless electrical pulses to nerves that control the bladder muscle to treat urge incontinence.
• Botulinum toxin (“Botox”).  This treatment injects a small amount of the toxin into the bladder muscle.
• Surgery. This may be necessary to treat stress incontinence in women.

Last Updated February 2023