These 9 treatments for overactive bladder, urge and stress incontinence have high success rates

Wearing bulky underwear shields day in and day out, forgoing your morning run for fear of leakage, avoiding funny movies because you're worried about laugh-induced accidents: If you suffer from overactive bladder (OAB) and/or incontinence, this does not have to be your life.

"Many women think they can't be helped, but that's a myth," says Mary Pat FitzGerald, M.D., a professor of obstetrics and gynecology in the division of Female Pelvic Medicine and Reconstructive Pelvic Surgery at Loyola University Chicago Stritch School of Medicine. Indeed, from easy-to-do exercises that strengthen the muscles around your bladder to cutting-edge electrical stimulation, doctors have an arsenal of treatments that can keep you from leaking and stop that desperate race to the toilet.

If you have OAB or urge incontinence, consider conservative treatments such as pelvic floor exercises and bladder retraining. If these don't help, your doctor may suggest medication or electrical stimulation.

Exercise is also the first step if you have stress incontinence. You may eventually need to consider surgery if symptoms don't ease. But remember: What works for one person may not be right for you. And you may have to try several approaches (or a combination) to find relief. To help chart your route, here are some common therapies for OAB and urge and stress incontinence.

1. Pelvic Floor (Kegel) Exercises

Best for OAB & stress incontinence

How it works These moves strengthen pelvic floor muscles, which support your uterus, bladder and bowel, preventing leakage. Strong pelvic muscles also keep the bladder from contracting at the wrong time.

Success rate Eighty-three percent of women in a six-week pelvic floor exercise program at Rush University Medical Center in Chicago experienced decreased urine leakage. In addition to exercise, the program included educational sessions on bladder and pelvic health. (The women in the control group showed no significant positive changes.)

Cost Covered by most insurance; your health care provider guides you

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2. Bladder Retraining & Urge Suppression

Best for OAB & urge incontinence

How it works Both forms of behavioral therapy work together to help women who have a strong urge to urinate even if there's only a tiny amount of urine in the bladder. First, you keep a bladder diary, charting how much you drink, how often you use the bathroom and how much you urinate. Based on the findings, your healthcare provider sets up a voiding schedule. The goal is to gradually increase the length of time between bathroom visits.

Rushing and stress can worsen bladder symptoms. Successful bladder retraining requires you to learn to distract and calm yourself until the desire eases (urge suppression). "This helps break the nerve reflex and relax the bladder," explains Diane K. Newman, C.R.N.P., co-director of the Penn Center for Continence and Pelvic Health at the University of Pennsylvania Medical Center.

Success rate Behavioral training with the help of biofeedback (which uses devices, such as electric sensors, to give you info on how well pelvic muscles are contracting) has been shown to reduce incontinence up to 86 percent.

Cost Covered by most insurance; your healthcare provider guides you

3. Medication

Best for OAB & urge incontinence

How it works While not a cure, antimuscarinic medications (which work by blocking overactive nerve signals) can increase bladder capacity and reduce bladder contractions. Your doctor may prescribe medicine right away to control symptoms while you try bladder retraining, urge suppression and exercises. Or she may wait to see if these treatments help before issuing a prescription.

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"Both behavioral therapy and medication work, but combining them gets better outcomes,” says Kathryn Burgio, Ph.D., a senior scientist at the Center for Aging at the University of Alabama, Birmingham. Potential side effects include dry mouth and drowsiness.

Success rate After eight weeks of drug therapy, 69 percent of people had improved incontinence symptoms, according to a study in the Journal of the American Medical Association.

Cost Covered by most insurance

4. Urethral Injections

Best for Stress incontinence

How it works After you receive a local anesthetic, your doctor uses a tiny needle to inject the area around your urethra with a bulking agent (these are space-filling substances such as artificial collagen) that helps keep the bladder from leaking.

Success rate Ninety-three percent of women considered their stress incontinence improved or cured after the first or second injection, according to a 2009 study in the Journal of Urology. "But if a patient doesn't maintain relief after two or three injections, I stop," says Kenneth M. Peters, M.D., director of the Women's Urology Center at William Beaumont Hospital in Royal Oak, MI. In addition, results may wane within six to 18 months, and you may require additional injections.

Cost Covered by most insurance

5. Transvaginal Electrical Stimulation

Best for Stress & urge incontinence

How it works A tampon-sized probe that's equipped with an electric wire is inserted in the vagina. Once the probe is in place, you turn it on with an external remote control-like device that delivers a low level of stimulation. (It may feel like gentle pulling.) Use the probe twice a day for about 20 minutes a session, for eight weeks. "It seems that applying a low voltage inside the vagina activates nerves at the base of the bladder, helping the brain control urges," Dr. FitzGerald explains.

Success rateA study in the British Journal of Urology International found that 88 percent of patients had a significant dip in symptoms after six months of treatment.

Cost Covered by most insurance

6. Sacral Neuromodulation

Best for OAB & urge incontinence that hasn't been eased by other therapies

How it works Your doctor surgically implants a small battery-operated device called InterStim in your upper buttock. The device then sends a constant, yet painless, signal via an electrode to the sacral nerves in your lower back. (It's thought that this helps facilitate better communication between your brain and bladder.) "Over time, your body gets used to the stimulation and you don't feel it," Dr. Peters says. The battery needs replacing every five years, but the device is permanent.

Success rate About 80 to 90 percent of people see a benefit within 24 hours to two weeks. Results vary, but Dr. Peters says some of his patients have improved about 50 to 90 percent.

Cost Covered by most insurance

7. Percutaneous Tibial Nerve Stimulation (PTNS)

Best for Mild to moderate OAB & urge incontinence that hasn't been helped by other therapies

How it works Your doctor inserts a tiny needle electrode near your tibial nerve. This is just above the anklebone. The electrode sends painless electrical stimulation to the nerves that help control bladder function. You'll likely feel some tingling in your leg during the procedure. This treatment requires weekly half-hour sessions for 12 weeks, then once-a-month visits for life.

Success rateDr. Peters recently led a 12-week study of 220 women with OAB. Half received weekly 30-minute treatments with PTNS and half received a sham therapy. He found that 55 percent of women who received PTNS had a moderate or marked improvement in symptoms.

Cost PTNS is new, so it's currently covered in only 30 states; $120 per session

8. Pessary

Best for Stress & urge incontinence associated with pelvic organ prolapse.

How it works If surgery isn't for you (see below), your doctor may suggest a pessary. It's a small silicone device similar to a diaphragm, which is inserted high into your vagina to help support the uterus, bladder and rectum. Your doctor will measure you, show you how to insert the device and check the fit. Once it's in, you won't feel it, but you will need to remove and clean it with soap and water about once a week (more frequently during your period). Pessaries can irritate the vagina and cause some discharge. And you may have to take it out during intercourse. Ask your doctor.

Success rateA 100-person study in the American Journal of Obstetrics and Gynecology found that after two months, 45 percent of women who had been fitted with a pessary saw their symptoms of stress incontinence ease. Some 46 percent reported that urge symptoms had improved.

Cost Covered by some insurance; $30 and up

9. Surgery

Best for Stress incontinence that hasn't been eased by other treatments

How it works There are two categories of incontinence operations: the sling and the retropubic suspension procedure. In sling procedures, the surgeon uses synthetic mesh tape or natural tissues to create a hammock-like support under your urethra, says Ariana L. Smith, M.D., assistant professor of surgery and urology at the University of Pennsylvania School of Medicine. Several different types of sling procedures are available; most are outpatient surgeries and take about 30 minutes. You can return to work the next day, but strenuous activities like exercise and sex are off-limits for about six weeks.

With the retropubic suspension, a surgeon sews tissues from your bladder neck, urethra and vagina to the tissue around the pubic bone. This narrows the urethra and bladder neck (which connects to the urethra) to reduce leakage. Surgery takes an hour. You'll probably spend one night in the hospital and miss a few weeks of work. Activities such as lifting, exercise and intercourse are prohibited for about six weeks.

Success rateOne recent study in the New England Journal of Medicine found that the cure rate for two sling procedures ranged from 78 to 81 percent. While the positive effects can last a lifetime, they often wear off and require a second operation. In regard to the retropubic suspension, a 2007 study found that 78 percent of women who underwent the surgery were happy with results.

Cost Covered by most Insurance.

Surgery: Is it Worth the Risk?

Surgery for stress incontinence has potential side effects, such as a urinary tract infections or temporary trouble urinating, but "the odds are in your favor that these complications won't happen," Dr. FitzGerald of Loyola University says. "Any risks are far outweighed by the likelihood that you'll be cured. It's rare to be worse off than when you started." But that doesn't mean surgery is for everyone. "We only recommended it for women who are done having children," Dr. FitzGerald says. (It's unknown how pregnancy affects incontinence surgery.) In addition, elderly women are often advised against surgery since they're more likely to have other health issues that could make the procedure dangerous.

Botox: A promising new therapy

Botox may not be just for wrinkles: Getting 10 to 30 shots of botulinum toxin-A directly into your bladder may improve symptoms of OAB and urge incontinence. "Botox relaxes the bladder, allowing it to contract normally. It can be a fantastic treatment for some,” says Loyola University's Dr. FitzGerald. Benefits kick in around the two-week mark and, in studies, have lasted up to six months.

A 2009 report in the British Journal of Urology International found that patients who previously were not helped by medication experienced steady improvements in areas such as physical and social limitations, severity of symptoms, sleep and personal relationships. Botox was approved by the U.S. Food and Drug Administration (FDA) to treat overactive bladder in January 2013.

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 17 Mar 2011

Last Modified: 06 Feb 2015