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Nonsurgical Options for Urinary Incontinence

In the United States, a quarter to a third of Americans—roughly 81 million to 108 million people—deal with urinary incontinence. Of those, many don’t seek help because they think frequent urination or leakage problems are a permanent issue.

But there’s a fix—in some cases, it’s surgical. Surgeons can perform a vaginal sling procedure, in which a piece of tissue or synthetic material is used to create a sling around the urethra, and sacral nerve stimulation via an implanted neurostimulator device.

However, Samantha Pulliam, MD, director of UNC Urogynecology and Reconstructive Pelvic Surgery, says these options should be recommended only after less invasive treatments have been explored. “In most cases, the least invasive option is probably the right choice,” Dr. Pulliam says.

Treatments for Urgency Incontinence

For urgency incontinence, the following treatments can help relax the bladder:

Medication. Before more invasive treatment, medications might be recommended to help lessen the urge to urinate. Anticholinergics, which help inhibit the nerve impulses that cause involuntary muscle movements, might be prescribed. “There are eight or nine different medications that meet this category, so another alternative is to try a different medication,” Dr. Pulliam says.

A newer medication called mirabegron, which is in a different class than anticholinergics, might also be prescribed to relax the bladder muscle. However, it can be expensive and often requires a trial of more budget-friendly medicines first.

Botox. “Botox helps calm the irritable nature of the bladder and allow the bladder to expand more and hold more urine in,” Dr. Pulliam says. The injection, which is delivered directly into the bladder, helps increase the interval between urination and allows people to reach the bathroom in time.

Treatments for Stress Incontinence

Unlike urgency incontinence, stress incontinence happens when physical activity such as coughing, sneezing or running puts pressure on the bladder. Along with Kegel exercises, Dr. Pulliam says the following treatments can help prevent leakage:

Vaginal Pessaries. The pessary pushes underneath the urethra to support it. This extra support increases outflow resistance and corrects the angle between the urethra and bladder, which can prevent leakage.

Urethral Bulking. This procedure involves injecting a bulking substance, such as collagen, around the urethra to either close a hole or build thickness in the urethral wall so it can withstand pressure from physical activity.

However, the effects of urethral bulking don’t last as long as those of other stress incontinence treatments, Dr. Pulliam says. As a result, the procedure is commonly reserved for older patients who are not good surgical candidates.

Pelvic Floor Physical Therapy

Another nonsurgical option for both urgency and stress incontinence is more formal training in pelvic floor therapy. “Seeing a physical therapist can help to ensure that the pelvic floor muscles are working properly and are strong enough either to inhibit leakage or to calm the bladder to resist an urge,” Dr. Pulliam says.


Learn more about the procedures offered at UNC Urogynecology and Reconstructive Pelvic Surgery.