Strengthening the pelvic floor muscles through an exercise programme supervised by a dedicated Physiotherapist can result in a marked symptom improvement for 6 in 10 women with stress incontinence. Your Physiotherapist may also recommend additional electrical stimulation to the pelvic floor muscles to aid in their strength training. Weight loss is also recommended in conjunction with all treatments as it can contribute 5-10% to subsequent success rates.
General lifestyle modifications and bladder retraining can work well in up to half of the cases with urge incontinence. These simple measures involve caffeine and alcohol reduction, both of which are bladder stimulants often exacerbating urgency symptoms, advice regarding appropriate fluid consumption and training to break the habit of “just in case” toileting.
If adequate improvement is not achieved through bladder retraining for urge incontinence symptoms then the additional prescription of medication known as antimuscarinics can complement this therapy. These medicines work by blocking nerve impulses to the bladder thereby relaxing the muscle and increasing the bladders capacity. Side-effects of dry eyes and dry mouth, constipation and blurred vision are quite common with these medicines but are often minor and tolerable.
An alternative oral medication is Mirabegron which increases bladder capacity and the time interval between voids.
Various surgical operations are available to treat stress incontinence, when pelvic floor muscle training has not achieved an adequate response, offering success rates of up to 80- 90%.
The tension-free vaginal tape (TVT or TVT-O) procedure involves inserting a sling of synthetic mesh tape to support the urethra (tube to pass urine from) and bladder neck. With this additional support the urethra is able to function satisfactorily and prevent urinary leakage. This minimally invasive day case procedure can be performed under local or general anaesthetic and requires a single vaginal incision with a rapid return to normal daily activities.
Injection of Botulinum toxin A to the bladder wall can be used to treat urge incontinence when bladder retraining and oral medication has not succeeded. This is performed via a telescope (cystoscope) that is passed down the urethra under a local or general anaesthetic. The treatment has the effect of relaxing bladder muscle contractions but may require repeated treatments to maintain effect.