How Do You Treat Urinary Incontinence?

Dr. Dean Elterman, MD, MSc, FRCSC, Urological Surgeon

Duration : 3 minutes and 10 seconds

In terms of treatments, what's notable is that first line treatments are the same for both. It's those behavioral lifestyle modifications, and pelvic floor physiotherapy that is the cornerstone of being able to treat both types of urgency and stress incontinence. For the stress incontinence, the coughing, laughing, sneezing, type of leakage, the physiotherapist can give Kegel exercises. These can be really helpful. Beyond that, the classic typical surgery would be something called a sling which is like a little piece of mesh put under the retract to help support and lift it up. There are some other types of treatments like bulking agents, which are these little injections that we can put around the urethra. And of course for women who can't or don't want to have surgery, there are temporary inserts that can go into the vagina like column incontinence pessaries. There's a device called a Poise Impressa, which you can buy in the drugstore.

These are the treatments for incontinence and there's even some lasers that can go inside the vagina to help kind of build up collagen and help lift up and support the bladder, neck and urethra. On the other side of things, treatment of urgency incontinence is really just treatment of the overactive bladder. So we start with physiotherapy and the lifestyle changes and then we can give medications that are specifically designed to treat overactive bladder, and those will of course help reduce leakage of urine.

Beyond medications, there are things like Botox injection into the bladder, or sacral neuromodulation which is a bladder pacemaker.

A unique subset of people would be men who develop incontinence after prostate surgery. One of the rare times that men can develop stress incontinence is after prostate surgery. In this case, we still want to try physiotherapy, but if this doesn't work, we do have a number of surgeries for men with stress incontinence, such as again a sling operation or even an artificial urinary sphincter, which is almost like a pump that can go inside to open and close and help prevent loss of urine.

An important takeaway, just like many other conditions, is it does happen more commonly in older people but it doesn't necessarily mean that you have to live with it or accept it because there are many really good treatments available. Speaking to your doctor about it can be very helpful, so that they can help guide you towards a treatment that could potentially cure or at least reduce your leakage.

Presenter: Dr. Dean Elterman, Urologist, Toronto, ON

Local Practitioners: Urologist