Treatment of urinary incontinence should be tailored to each patient’s needs and specific type of incontinence. In mild cases of stress incontinence
, behavioral modification and pelvic floor muscle exercises can be tried in the beginning. If these fail or in women with severe stress incontinence, oral medications or surgical procedure can be tried.
Presently, there are many simple surgical procedures which have a high degree of success and also give long term relief. All the surgical procedures create support for the urethra and bladder neck, to prevent urine leakage during physical activity. The various sling
and suspension procedures are performed through very small incisions in the lower abdomen or in the vagina, permitting early return to activity. Many patients with stress incontinence also have other conditions like bladder prolapse, rectocele or uterine prolapse that must be treated at the same time The time spent in the hospital normally ranges from 1 to 3 days, depending upon the type of procedure.
Complications such as infection may occur, but are usually easily treated. Retention of urine is a possible complication, but is temporary in most cases. During this period the urine is drained either with a catheter left in the bladder, or by self catheterisation.
The first step should be behavior modification like drinking less fluid, not drinking at bedtime and timed voiding around the clock. Exercising the pelvic muscle
(Kegel exercises) also helps. The mainstay of treatment is medication called bladder specific anticholinergics. This consists of the use of bladder relaxants that prevent the bladder from contracting without the patient's permission. The most common side effect of the medication is dryness of the mouth, constipation or changes in vision. Sometimes, reduction of medication takes care of the side effects.
In more difficult cases, the bladder can be made bigger using a segment of small intestine. This operation called augmentation cystoplasty, is very successful in curing incontinence, but its main drawback is the need in 10 to 30 percent of the patients to perform intermittent self-catheterization
to empty their bladder.
In patients who don’t respond to anticholinergics or those who cannot tolerate the side effects of these drugs, option of Botox injection to the bladder is available. The advantage is no need of medications and more sustained effect and the disadvantage is the dose may need to be repeated after 6-9 months.