The treatment of urinary incontinence will depend, in part, upon the type and cause of the incontinence. In most cases, treatment begins with conservative therapies, such as changes in lifestyle and potentially reversible factors, behavioral treatments, or a pessary. If these therapies are inadequate, medication or surgery may be considered.

Before embarking on a treatment plan, the patient and clinician should discuss the goals of treatment in detail, as these will not be the same for every patient.

Treatments for stress and urge incontinence — The following treatments may be helpful for persons with stress, urge, or mixed incontinence.

Fluid management — Persons who drink large amounts of fluids (especially those containing caffeine) may find that cutting back decreases the frequency of their leakage. The body requires a certain amount of fluids to function; for most people, thirst is a good indicator of when fluids are needed. Persons who are older may need to make a special effort to drink enough as they may not become thirsty in the initial stages of dehydration.

Drinking excessive amounts of fluid is of little benefit despite the popular misconceptions that drinking water can "flush out toxins," improve skin health, or assist with weight loss. Between 32 and 64 ounces of fluid per day (from food and fluids) is sufficient for most people; more fluids may be needed for persons who are active and perspiring or when outdoor temperatures are high. Decreasing evening fluid intake (eg, no fluids after 6 to 7 P.M.) is advised for persons with frequent nighttime voids or overnight leakage.

Potentially reversible factors — Patients who take certain medications (such as diuretics ("water pills")), have swollen ankles or feet (edema), are diabetic and have elevated blood glucose levels, and those who have difficulty walking may be at increased risk for urinary incontinence. A variety of techniques can be used to reduce symptoms.

Persons who take diuretics should take them at a time when there is easy access to a bathroom.

Persons with edema should elevate their feet for several hours in the afternoon or evening, and may consider wearing graduated pressure stockings, or in some cases can take a diuretic in the afternoon. Some prescription drugs and over-the-counter medications (e.g., ibruprofen and other nonsteroidal anti-inflammatory agents) can worsen edema; check with your healthcare provider. these measures may help to reduce overnight frequency, urgency, and leakage.

Persons with diabetes who have elevated blood glucose levels should work with their healthcare provider to reduce blood glucose. Elevated blood glucose levels cause the kidneys to produce more urine, which can increase frequency, urgency, and leakage.

Persons who have difficulty walking should be evaluated for interventions such as physical therapy, which could improve mobility. These persons may benefit from a portable toilet that can be placed close to their bed or living area. Potential obstacles such as electrical cords, throw rugs, or furniture should be moved out of hallways and walkways.

Pelvic muscle exercises — Pelvic muscle exercises, also known as Kegel exercises, strengthen the muscles involved in closing the urethral sphincter. These are used primarily for stress incontinence but can also be used to control sudden urges in persons with urge incontinence

Studies have shown that, when done correctly, pelvic muscle exercises can be effective in people with stress incontinence. Patients may benefit from a visit to a physical therapist, or a urology, gynecology, or geriatric nurse specialist for detailed instructions. Biofeedback may also help teach correct exercise technique.

Treatments for urge incontinence Bladder irritants — Some foods and beverages are thought to contribute to frequency and urgency. This includes caffeinated beverages and alcohol, spicy foods, and acidic foods or beverages. While this has not been proven, it may be reasonable to see if eliminating one or all of these items helps.

Bladder retraining — Normally, a person should urinate approximately every three to four hours during the day; getting up once during the night to void is normal for older persons. Bladder retraining can help persons with urge incontinence by slowly increasing the amount of urine the bladder hold, and therefore the time interval between voids.If the patient feels the need to urge sooner, they should not to run to the bathroom, but should stand still or sit down and concentrate on decreasing the urge, usually while doing several pelvic muscle contractions (see "Pelvic muscle exercises" above). Once the urge has decreased or passed, the patient can walk slowly to the bathroom to urinate. After one to two weeks, the time interval can be increased by 30 to 60 minute increments. The goal is to increase the voiding interval to a more normal pattern, approximately every 3 to 5 hours. This regimen retrains the nerves and pelvic muscles, which can improve control of bladder contractions. Patients are instructed to urinate at specific intervals through the day, starting with a small time interval. For example, a person who must currently void every 30 to 45 minutes would start by voiding every 45 minutes, whether there is an urge or not.

For patients with dementia or memory impairment, treatment focuses on encouraging the patient to use the toilet at regular intervals (usually every two to three hours) and providing positive feedback for successful toileting.

Constipation — Constipation can lead to fecal impaction (when stool collects and is difficult to pass from the rectum), which can increase symptoms of frequency and urgency. Patients can prevent constipation by increasing the amount of fiber in their diet to between 20 and 30 grams per day

Medications — When bladder retraining and fluid management alone are not successful in treating urge incontinence, medications can be added. Medicines that are available are called bladder relaxants or antimuscarinic agents. Medications work best when combined with behavioral therapy. In general, these drugs have similar effectiveness, but may differ somewhat on the type and severity of side effects, such as dry mouth, constipation, and heartburn.

Patients and their clinicians should wait at least 4 weeks to determine the response to a medication. A patient who does not respond to one drug may respond to another. Patients who take these medications for long periods of time need to practice good dental care because dry mouth can increase the risk of cavities. There is a small risk of urinary retention (causing the bladder to incompletely empty) with these medications, especially in older patients.

Oxybutynin comes in three forms: immediate release (generic oxybutynin, taken two to three times daily), extended release (Ditropan XL®, taken once daily), and a patch (Oxytrol®, which is worn on the skin and changed twice weekly). The immediate release form is particularly useful for people who require protection at specific times (eg, when going out to dinner) since it begins to work quickly and wears off after about six hours. Side effects occur less frequently with Ditropan XL® and Oxytrol®.

Tolterodine is available in an immediate release form (Detrol® 1 or 2 mg, taken twice daily) and extended release (Detrol LA®, 2 or 4 mg taken once daily). Side effects occur less frequently with Detrol LA®.

Trospium (Sanctura®) is taken one or two times daily on an empty stomach, and is available in 20 mg.

Solifenacin (Vesicare®) is taken once a day, and is available in 5 mg or 10 mg.

Darifenacin (Enablex®) is taken once a day, and is available in 7.5 mg and 15 mg.

Treatments for stress incontinence

Weight reduction — Obesity can contribute to symptoms of stress or mixed incontinence. In persons who are obese, weight loss can significantly reduce episodes of leakage due to stress incontinence.

Medication — There is currently no medication available for treatment of stress incontinence. Use of oral estrogen in women was found to worsen stress incontinence. Whether topical estrogen cream can improve incontinence is controversial.

Vaginal pessaries — A vaginal pessary is a flexible device made of silicone that can be worn in the vagina (show figure 6). It is traditionally used for women with pelvic organ prolapse (when the bladder, vagina, uterus, or rectum bulge from the vagina), but specially designed stress incontinence pessaries are also available. These help to support the urethra during a cough or sneeze, and may reduce or eliminate stress or overflow incontinence. A pessary is a reasonable treatment for women who want to delay surgery and for those who prefer a non-surgical treatment. When fit properly, the woman will not feel the pessary.

The pessary must be removed and cleaned with soap and water periodically. In addition, there is a small risk that the pessary can cause irritation of the vaginal tissues. Most women who use a pessary see their healthcare provider every three to six months for an examination. Some women are able to learn how to insert and remove the pessary on their own; this is especially helpful for women who are sexually active.

Periurethral bulking injections — In selected women, stress urinary incontinence is caused by complete failure of the urethral sphincter muscles; this is called intrinsic sphincter deficiency (ISD). This may occur in women who have had previous pelvic surgery or radiation treatment and later developed scarring, but it can also occur in postmenopausal women who have severely thinned (atrophic) vaginal tissues. ISD leakage is typically continuous and can occur while sitting or standing quietly.
,br> Women with ISD may gain some short term benefit from injection of material into the wall of the urethra to help keep the urethra closed. These are called periurethral bulking injections. Materials injected include collagen, Teflon®, silicone, and carbon-coated beads.

Surgical treatments for women — Surgery offers the highest cure rate of any treatment for stress urinary incontinence, even in elderly women. Cure rates vary by procedure and by length of time since surgery, although most procedures result in 85 to 95 percent of women being cured at six weeks after surgery; cure rates tend to decrease over time. Ideally, surgery should be reserved for women who have completed childbearing because pregnancy and childbirth can cause damage to the urethral supports, potentially causing incontinence to recur.

There are several surgical procedures for the treatment of SUI in women. The best procedure depends upon several factors. Each procedure has its own risks, benefits, complications, and chance of failure. Long-term outcomes are not always known because some procedures have not been used long enough to measure the incidence of incontinence 10 to 20 years after surgery; the risk of incontinence recurring at a later time is difficult to know in these situations. All of these issues should be discussed in detail with the surgeon.

Other measures

Pads — While pads are not a recommended treatment for incontinence, they are necessary for some persons who are unable or unwilling to use behavioral treatments, medications, or more invasive treatments, or who have incomplete relief of leakage despite treatment. Pads and protective undergarments are available for both men and women in a large variety of sizes and absorbencies. The choice of garment depends upon the type, frequency, and volume of urinary incontinence leakage. Pads designed for menstrual bleeding may be insufficient for persons with sudden, large volume leakage. In addition, menstrual pads typically do not manage urine odor as well as incontinence products. Men may prefer a penile sheath to a pad; the sheath covers the penis like a condom, and is connected to a tube and bag that collects the urine.

These items are expensive and are usually not covered by insurance; in some states within the United States, Medicaid may cover pads for people of very limited income, while in other countries pads may be obtained for no or little cost through continence advisor nurses. Information on pad varieties and other urinary incontinence supplies is available from medical supply companies and urinary incontinence patient advocacy groups (). The U.S. National Association for Continence has an online tool that can help a patient to choose a protective garment based upon individual characteristics

For all protective products, it is important that the skin is kept dry and that odor is managed. Skin that is exposed to urine for long periods can cause skin irritation, and can potentially cause skin burns or infection. In addition to protecting the skin, patients may need protective products for their bed or other furniture.

Catheters — A catheter may be necessary in some patients who cannot empty their bladder completely or at all. Because catheters (especially those left in place for long periods) can cause urinary tract infections and other serious complications, they are usually a treatment of last resort.

A catheter may be inserted and left in the bladder, or may be inserted as needed to drain the bladder, and then removed. A healthcare provider can teach the patient or a family member how to perform catheterization at home.