Urge Incontinence treatments include diet modification, Kegel exercises and surgery.
Treatment options for urge incontinence range from watchful waiting to surgery. As urge incontinence is primarily a quality of life issue and not a life threatening issue, treatment can be delayed until the time it causes significant bother.
Modification of fluid and food intake can improve urge incontinence in some patients. Decreasing caffeine beverages, carbonated beverages, alcohol, and spicy foods may improve bladder dysfunction. Altering fluid intake to slow sipping over the day from bolus intake can improve frequency and urgency.
Some patients can benefit from pelvic muscle exercises. These levator muscle exercises, also known as Kegel exercises are often suggested for treatment of stress incontinence. Often, pelvic muscle exercises are better at treating urge incontinence than stress incontinence. The limitation of Kegel exercises is the ability of the patient to perform the exercises correctly. This is important as the goal is to affect only those muscles in the same neurologic distribution as the bladder and urethra (ie levator muscles). Biofeedback is a way of doing monitored Kegel exercises in the office. Biofeedback is a very effective way of treating urge incontinence. For those patients unable to perform biofeedback, electrical stimulation of the pelvic floor can be performed.
Several medications have been released in the last five years for treatment of urge incontinence. All the medications in this category (muscarinic receptor antagonists) will hopefully decrease muscular activity in the bladder during the filling phase therefore decreasing abnormal contractions that can lead to urge based bladder leakage. Though the medications in general affect the same receptors in the bladder wall, some medications will work for some patients and not for others. As a consequence, it is often necessary to try several medications before moving on to other therapeutic options.
Surgical options for urge incontinence exist for patients that have not seen benefit from conservative measures, biofeedback or medications. Cystoscopy with hydrodistention of the bladder is occasionally performed in patients with urge incontinence but is more often performed in patients with urgency and frequency of urination. Sacral nerve stimulation (InterStim) is the most common FDA approved surgical treatment for urge incontinence. InterStim therapy comprises a testing phase that is either performed under local anesthesia in the office or in the operating room. Patients in whom a greater than 50% improvement is realized from the testing phase move on to surgical placement of the implantable pulse generator. Botox injections in the bladder are not approved by the FDA but are occasionally used in patients after failure of standard medical and surgical therapy for urge incontinence. Tibial nerve stimulation can also be used to treat patients with medication-refractory urge incontinence. Pudendal nerve and dorsal genital nerve stimulation are in clinical trials for urge incontinence patients. If all fails, augmentation cystoplasty can be explored as a surgical option.