Everything You Need To Know About Urinary Incontinence Treatments

Treating urinary incontinence can feel daunting. There is a range of urinary incontinence treatment options, and it’s hard to know which is best. Chatelaine asked two experts—a pelvic floor physiotherapist and a urologist—about common treatment plans. Here’s what they say works—and what to avoid.

Pelvic floor therapy

Pelvic floor physiotherapy is typically one of the first lines of treatment for incontinence. First, a pelvic floor physiotherapist will assess a patient’s incontinence history, and perform an internal and external exam. They’ll then create a holistic treatment plan, which can include customized Kegel exercises to strengthen bladder muscles, breathing techniques, full-body stretches and lifestyle changes. Internal or external manual therapy—involving pressure or gentle massage—is also often recommended.

Priyanka Gulati, a pelvic floor physiotherapist at Corelife Wellness in Oakville, Ont., says the treatment works for at least 90 percent of her patients, and three months of physiotherapy is usually enough to help patients increase pelvic floor strength and endurance.

The Kegel Throne

The Kegel Throne is a popular new treatment used to strengthen pelvic floor muscles. Patients sit fully clothed on a chair while electromagnetic energy delivers more than 11,000 contractions—essentially, Kegels—per session. At least six sessions, each lasting about 30 minutes, are recommended for long-term improvement. 

The Kegel Throne can be effective in treating both mild incontinence, which some women experience after childbirth, as well as more severe cases, says Gulati. But patients shouldn’t rely on the chair alone for results, she cautions; the Throne works best when combined with lifestyle modifications and strengthening and relaxation exercises provided by a professional.

Oral medications

When lifestyle changes are ineffective, doctors will often prescribe oral medications for women who suffer from urge incontinence. Medications fall into two classes: beta-3 adrenergic and anticholinergic. While they work slightly differently, both relax the bladder, allowing it to hold more urine and reduce urgency. 

“For overactive bladder or urgency-related urinary incontinence, medications are quite successful, but they do have a lot of side effects,” says Dr. Jennifer Locke, a urologist at Locke MD in Kelowna, B.C. They can include everything from dry mouth and constipation to blood pressure problems and cognitive impairment, which is why some patients stop using them despite their efficacy, she says.

Bladder retraining

Bladder retraining is a non-invasive option for those experiencing stress or urge incontinence. It involves going to the bathroom at fixed intervals to retrain the bladder to hold more urine and for longer periods of time. 

With time, bladder retraining can be helpful for some. “Stress incontinence has a 50 percent chance of being effectively treated with bladder retraining and pelvic floor physiotherapy, which is great,” Locke says.

Combining lifestyle changes—such as avoiding coffee, tea, juice, pop and other bladder irritants—with training, along with special techniques such as relaxing the pelvic floor when urinating, can help reduce urgency and leakage.

Pessaries

An incontinence ring is a type of vaginal pessary, or a soft removable device inserted into the vagina. Pessaries are typically used in women who suffer pelvic organ prolapse, a condition in which the bladder, uterus or rectum drops down toward the vagina as a result of pregnancy, childbirth or menopause. But incontinence rings can also help prevent leakage from coughing or sneezing by providing support to the vagina and urethra.

Women who have stress incontinence and experience pelvic organ prolapse but are unable to have surgery would be good candidates for this type of pessary, Locke says. 

Botox

Botox works much in the same way for bladder muscles as it does for muscles in the face: It causes them to relax by preventing them from contracting. The 20-minute procedure involves the application of local anesthetic to the urethra and bladder before a doctor injects Botox into the bladder wall through a small instrument called a cystoscope. 

Botox improves bladder control for women who have leakage due to urge incontinence and an overactive bladder, Locke says, but it is an expensive procedure and needs to be injected regularly—usually every six months or so. 

Vaginal laser therapy

Vaginal laser therapy is a relatively new and painless treatment for incontinence, in which a wand-like device is inserted inside the vagina to deliver pulses of thermal energy to the vaginal wall. This stimulates the growth of new tissue, which is said to better support bladder and urethra function.

But it’s not yet known if the treatment works for incontinence specifically, says Locke. Gulati agrees there is little evidence of laser therapies—such as the well-known MonaLisa Touch—being effective as a standalone treatment, but they may help if paired with other therapies that boost pelvic floor health.

Start small

Both experts recommend women try conservative lines of treatment—which can be successful enough on their own—first. That means working with a health professional to make changes to diet and lifestyle, bladder training and pelvic physiotherapy before considering other treatments or surgery.

Learn more about urinary incontinence