Medical and Surgical Treatments for Urge Incontinence
If behavioral modifications such as timed voiding and bladder training do not improve the symptoms of urge incontinence, your doctor may decide to try various medical or surgical treatments. These methods have the same goal -- relief of the symptoms and inconvenience of urge incontinence.
Medical treatments for urge incontinence include:
- Medications: There are several medications that are used to treat urge incontinence. They include:
Oxybutynin (Ditropan, Ditropan XL, Gelnique, Oxytrol)
Tolterodine (Detrol, Detrol LA)
Oxytrol for women is the only drug available over the counter.
Your health care provider may also recommend other medications that may help control bladder spasms. They include hyoscyamine (Anaspaz, Cystospaz, Hyosol, Hyospaz, Levbid, Levsin) or dicyclomine (Antispas, Bentyl, Byclomine, Di-Spaz, Dibent, Or-Tyl, Spasmoject).
If behavioral treatments and medications do not help, other options for treatment include:
The drug Botox injected into the bladder muscle causes the bladder to relax, increasing its storage capacity and reducing episodes of leakage. It can be used in adults that do not respond to or cannot use other medications that treat overactive bladder.
Another drug treatment that may be helpful for some women is hormone therapy, which uses estrogen alone or in combination with progesterone. However, evidence of benefit for urge incontinence has been mixed. In addition, because of the possible risks of hormone therapy -- including a potential increased risk of blood clots and breast cancer -- you should discuss this therapy with your doctor.
- Electrical stimulation:
Sacral nerve stimulation: An electronic device is implanted in the back through a minimally invasive procedure. The device delivers an electric signal to the sacral nerve. This signal helps to control the bladder muscles and decrease the number of abnormal contractions.
Percutaneous Tibial Nerve Stimulation: An electric current is applied to the tibial nerve in the region of the patient's ankle. This nerve is thought to affect bladder contraction.
Another technique is to use small electrodes placed in either the vagina or the rectum. The electrodes produce electric pulses that cause contraction of the muscles of the pelvis and the urethra. This strengthens these muscles to help reduce the incidence of urge incontinence.
Surgical procedures for urge incontinence include:
- increasing the storage capacity of the bladder
- limiting nerve impulses to the control muscles
- diverting the flow of urine