While urinary incontinence is common, it is not normal at any stage in life. If your symptoms disrupt your work schedule, social interactions, physical activity or daily activities, UC San Diego Health female pelvic health specialists can help. We provide caring, individualized, and expert treatment for all types of incontinence, and our first line of approach is always nonsurgical. We are able to help more than half of our patients with a conservative approach.
Stress Incontinence Treatment Options
Stress incontinence is a loss of urine caused by increased abdominal pressure triggered by sneezing, coughing, or exercise and affects one out of three women over the age of 45. Obesity is the leading cause of pelvic floor disorders and even small reductions in weight can improve urinary incontinence. Other risks factors include pregnancy and childbirth, chronic coughing, constipation, smoking, and even extreme weight lifting.
Nonsurgical treatments for stress incontinence
- Pelvic floor muscle training (Kegel exercises) and
- Incontinence pessary, a silicon device that fits in the vagina or over the counter devices such as Impressa (TM)
- Urethral inserts, a silicon device that fits inside the urethra
Surgical treatments for stress incontinence
- Urethral bulking agent, an injection into the muscular wall of the urethra
- Slings: mid-urethral sling (the "gold standard" surgical treatment), which places a thin strip of permanent mesh under the urethra or autologous fascia sling, which uses your own tissue
- Retropubic suspension, a procedure where the surgeon places stitches to help lift the vaginal wall and urethra
Overactive Bladder Treatment Options
With an overactive bladder, you may feel a sudden urge to urinate that's difficult to control and may experience the involuntary loss of urine. You may also urinate frequently — more than eight or more times in 24 hours and also awaken several times during the night to urinate.
Nonsurgical treatments for overactive bladder
- Bladder control strategies and bladder training to help you wait longer between bathroom visits.
- Fluid management (drinking less than 2 liters of fluid a day) and avoiding bladder irritants such as caffeine
- Pelvic floor exercise (Kegel exercises) to suppress urge to urinate
- Overactive bladder medications
- Vaginal estrogen
Additional treatments for overactive bladder
- Botox bladder injections performed in our office under local anesthesia. Treatment results are similar to medications and sacral neuromodulation. Injections usually work for six to nine months and can be repeated.
- Peripheral tibial nerve stimulation, an acupuncture treatment that uses low-voltage electrical current to help control overactive nerves. Treatments are 30 minutes every week for 12 weeks, followed by monthly maintenance therapy if the treatment is successful.
- Sacral neuromodulation, an implantable system (similar to a heart pacemaker) that sends mild electrical impulses to the sacral nerves. This is performed as an outpatient surgical procedure under local anesthesia and can be tested prior to permanent implantation. Generally, the battery lasts five years and can be replaced as needed.