It is estimated that nearly 50% of adult women experience urinary incontinence, BUT only 25-61% of those seek care. This could be out of embarrassment, lack of knowledge of treatment options, or the fear of options like surgery. Don’t let any reason stop you, you deserve a solution and there are many out there. You just need to find the right solution for you.
There are a range of treatment options you should consider if you’re dealing with—or looking to prevent—urinary incontinence.
Many women are surprised to hear that I always recommend booking an appointment with a physical therapist as a first step in treating incontinence. Make sure to find one who has advanced training and specializes in pelvic floor care. You can gain a lot of valuable and specific information if they are trained in doing internal assessments and treatments as indicated. Some will even be able to do a functional ultrasound to see how your pelvic floor and core muscles are contracting during a kegel exercise.
For treatment, it can be especially effective if they are able to provide internal work. This internal work can help to break up adhesions and scar tissue that developed along the pelvic floor, which is common after a vaginal delivery. This work can free up muscle fibers and nerve fibers that aren’t contracting optimally so that you have more control, which is particularly important for initiating effective Kegel exercises. You need to make sure you have enough control to do Kegel exercises in proper form before you start to practice them and rebuild the strength of your pelvic floor and internal core muscles. Your pelvic tone can also be checked by your medical doctor during your physical pelvic exam (often done at the same time as your screening Pap test).
Personally, this was something I did postpartum after each of our 3 children were born and recommended for all of my postpartum patients before returning to regular exercise. You want to make sure everything is contracting as it is supposed to. Often women go back to their regular exercise without evaluating their pelvic floor health and if your pelvic floor and core aren’t optimally contracting together many exercises can strain and further compromise them and exacerbate symptoms.
Remember, it isn’t the large abdominal muscles of an abdominal crunch we are talking about here, but the small but ultra-important internal abdominal muscles that fire with our pelvic floor. They may be small but they are mighty and help support for almost every movement we do, from walking to rolling over, bending over, and getting up and down from a seated position! If this is something you have never looked in to, it isn’t too late.
Weight loss can have a significant impact on incontinence. If you have excess weight to lose, this is an important area of focus when discussing your treatment options. It is best to work with a health care provider to support you and find the optimal way for you to shed some excess pounds in a way that is indicated and healthy for you. It is definitely worth the work, as greater than 70% of overweight and obese women who lost between 5% to less than 10% of their body weight reported an improvement in incontinence symptoms after a weight loss intervention.
Dietary changes can also make a difference. It may be helpful to do a trial of eliminating foods that can be common triggers for incontinence. These include alcohol, caffeinated, and carbonated beverages. Being mindful of not drinking fluids in excess (eg. >64oz) or after dinner (especially if frequent nighttime urination is an issue) can help as well.
Pelvic Muscle Rehabilitation
Kegel exercises help strengthen muscles to provide a backbone for the urethra to compress on and reflexively inhibit detrusor muscle contractions. Ideally done through a specific pelvic floor and core re-training and strengthening program.
Biofeedback used in conjunction with Kegel exercises can help people gain awareness and control of their pelvic muscles.
Pelvic floor electrical stimulation can be provided by a specific machine such as a TENS that provides mild electrical pulses that stimulate muscle contractions in conjunction with Kegel exercises.
Vaginal weight training using a yoni egg, where small weights are held within the vagina by tightening the vaginal muscles, can help tone and support those muscles.
All of these muscular therapies can be supported by 1:1 physical therapy care.
Bladder training teaches people to resist the urge to void and gradually expand the intervals between voiding.
Toileting assistance uses routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.
Internal Inserted Devices
Pessaries are removable devices, made of flexible medical grade materials, that are fitted by a gynecologist or urologist and inserted into the vagina. These are especially helpful when there is a prolapse contributing to incontinence as the device provides a mechanical uplift that supports the bladder neck the way a toned pelvic floor should. It is inserted before activity to prevent leakage and is particularly helpful for stress incontinence, or for women who have not found complete improvement with pelvic floor muscle exercises. These devices are non-invasive and can generally be worn comfortably, making them a good alternative for women who are hoping to avoid surgery.
Vaginal Estrogen improves tissue health which can positively impact symptoms of urinary frequency and urgency & can reduce frequent urinary tract infections. There are several ways of applying estrogen vaginally to treat urinary incontinence, including vaginal estradiol inserts (Vagifem®, for example), or vaginal rings (such as Estring®), or you can get vaginal estriol from a compounding pharmacy.
Anticholinergic medications are used to treat incontinence in the US. They help to prevent urge incontinence by relaxing the sphincter muscles. Examples are: Oxybutynin (brand name: Ditropan); Tolterodine (brand name: Detrol®, Detrol® LA); and Solifenacin (brand name: VESIcare).
However these anticholinergics aren’t without side effects, the most common including:
- dry mouth
- blurred vision
- abdominal pain
Surgical options to correct specific anatomical problems are an option. These include sling procedures, bulking injections (such as collagen) and other surgical procedures to support or move the bladder to improve continence.
Acupuncture at certain points can help to improve symptoms. Electro-stimulation acupuncture can also be helpful.
Botox to the detrusor muscle can help with urgency incontinence but carries the risk of urinary retention.
A new, natural herbal treatment that I recently learned about and am really excited about is Urox. This is a blend of herbs, traditionally used for bladder health, that when combined have been shown to improve urinary symptoms for 50% of people within 2-4 weeks of use. I had the opportunity to speak to the developer of Urox and will share more about this product and how it works to support bladder health and reduce symptoms of incontinence soon.
The Bottom Line on Urinary Incontinence
While urinary issues can be frustrating, embarrassing, and hard to talk about, please take heart and know that there are many options that can improve or even completely resolve your symptoms.
As you consider your options, my recommendation is to start with the least invasive option first and then move systematically through treatment options from there. If those treatment options don't provide improvement, make sure to consult with your OBGYN and urologist for a collaborated decision on when prescription medication and surgical therapies are the best option (weighing the risks and benefits involved).
Don’t be afraid of sharing your concerns with your doctor, talking through the options, and trying a variety of approaches until you find what works for you.