For millions of people who experience bladder leakage, the first solution may seem obvious: pads, protective underwear or adult diapers.
But those products manage the leakage. They don’t treat what’s causing it.
Urinary incontinence — the loss of bladder control — is common, particularly as people get older, but it isn’t necessarily something you simply have to live with. Depending on what’s causing the problem, treatment can range from exercises you can do at home to physical therapy, medication, injections or medical procedures.
The first step is figuring out what kind of incontinence you have.
Not All Bladder Leakage Is the Same
One of the most common types is stress incontinence, which causes urine to leak when pressure is placed on the bladder. Coughing, sneezing, laughing, exercising, lifting something heavy or even getting out of a chair can trigger leakage.
Weak or stretched pelvic-floor muscles are often involved. These muscles help support the bladder and urethra. Pregnancy, childbirth, menopause, pelvic surgery and other changes can weaken that support.
Urge incontinence, sometimes associated with overactive bladder, is different. It causes a sudden, powerful need to urinate. The bladder muscle may contract when it shouldn’t, and a person may not reach the bathroom in time.
Some people have mixed incontinence, meaning they experience both stress and urge symptoms.
Because treatments differ, persistent or worsening leakage is worth discussing with a healthcare provider rather than assuming it’s simply part of aging.
Start With the Simplest Solutions
Treatment often begins without medication or surgery.
Pelvic-floor exercises, commonly called Kegels, strengthen the muscles that help control urination. They can be done almost anywhere and cost nothing, but improvement generally requires doing them correctly and consistently.
Bladder training can also help, particularly with urgency. Instead of immediately going to the bathroom every time the urge strikes, people gradually work toward longer intervals between bathroom visits.
For people who need more help, pelvic-floor physical therapy provides specialized training. A therapist can determine whether the correct muscles are being used and teach exercises and techniques for better bladder control.
Women with stress incontinence may also benefit from a pessary, a removable silicone device placed in the vagina to help support the bladder and urethra. It requires fitting by a healthcare provider but doesn’t require surgery.
Medication and Injections Are Options, Too
For people with overactive bladder or urge incontinence, prescription medications can help relax the bladder or reduce unwanted bladder contractions.
If those treatments aren’t successful, Botox isn’t just for wrinkles.
A healthcare provider can inject small amounts of Botox into the bladder muscle. The medication helps calm an overactive bladder and can reduce urgency and leakage. The effects aren’t permanent, so injections may need to be repeated. Botox can occasionally make it difficult to completely empty the bladder, so patients should discuss the benefits and risks with their provider.
Another injection treats a different problem.
Urethral bulking agents are used primarily for stress incontinence. A filler-like material is injected into tissue around the urethra, adding bulk that helps it close more effectively and keep urine from leaking. It’s a nonsurgical procedure, although additional treatments may eventually be needed.
When More Treatment Is Needed
People with persistent urge incontinence may also be candidates for nerve stimulation, which uses electrical impulses to influence the nerves involved in bladder control. Some treatments stimulate a nerve near the ankle, while another approach uses a small implanted device that targets nerves near the lower spine.
For stress incontinence that doesn’t improve with less-invasive treatments, surgery may be considered. A common option is a sling procedure, which provides additional support beneath the urethra to help prevent leakage when coughing, sneezing or exercising.
The important point is that there isn’t one solution for everyone — and protective underwear isn’t the only choice.
Bladder leakage can keep people from exercising, traveling, attending social events or simply feeling comfortable away from home. Instead of quietly adapting their lives around the nearest bathroom, people experiencing incontinence can ask their healthcare provider — including a urologist or urogynecologist — what’s causing the leakage and which treatments might help.
Sometimes the first step toward better bladder control may be surprisingly simple.
