Urinary Incontinence Treatment

Lose weight. In overweight or obese women, it has been proven that a 5–10% weight decrease can reduce the weekly episodes of urinary incontinence by up to 50%. Individuals are therefore advised to lose weight through their diets and by exercising.

Improve bowel transit. Reduce the effort required to defecate by following diet guidelines to improve chronic constipation; this will help avoid weakening the pelvic floor muscles.

Quit smoking. Will decrease the chronic cough and the impact on the pelvic floor muscles, and so you will experience fewer episodes of urinary incontinence. Furthermore, tobacco is a bladder stimulant, so quitting will also improve symptoms of urinary urgency.

Reduce intake or stop consuming bladder stimulants. Coffee, tea, alcoholic, fizzy, artificially sweetened and energy drinks, etc., all produce bladder spasms. Reducing consumption benefits women with symptoms of urinary urgency and an increased frequency.

Control fluid intake. You should consume around 1.5 litres of fluids per day. It is important to remember that a balanced diet already provides a portion of your required fluid intake. Individuals with urge or nocturnal incontinence should therefore try not to drink any liquids after mid-afternoon.

Moderate physical strain. It is important to engage in daily physical exercise. However, women with stress urinary incontinence or significant muscle weakness should avoid physical efforts that pose a risk to the pelvic floor muscles, such as high-impact activities (jumping, running). Recommended exercises include walking, swimming, and any activity that helps improve overall fitness without increasing abdominal pressure.

As a precautionary measure, you should always try to contract the pelvic floor muscles whenever practising physical exercise in order to counteract abdominal pressure and prevent possible episodes of urinary incontinence.

Pelvic floor muscle training programme. The purpose of these exercises is to strengthen the muscles surrounding the vaginal and anal areas. With proper muscle strength, urethral support increases during contraction, improving control over urine leakage (both stress-related, like when coughing, and urgency-related, to help reach the toilet without leaking). Pelvic floor exercises are not recommended without prior guidance from professionals, as they may be performed incorrectly.

To train patients, biofeedback techniques are sometimes used to identify whether the exercises are being done correctly; or electrostimulation, which activates the muscles with a small electrical pulse while the contractions are performed.

Devices. There are devices such as pessaries or tampon-like supports that alleviate stress urinary incontinence. They are inserted into the vagina to help support the urethra, although symptoms return when they are removed. They are very useful for women with stress urinary incontinence who have a cold or are playing sport. 

Botulinum toxin. Is a substance produced by a bacterium that causes muscle paralysis and is widely used in medicine. It is indicated for women with urgency urinary incontinence who have detrusor contractions (the muscle that contracts the bladder) during bladder filling, as detected in urodynamic studies.

Sacral neuromodulation. This is a device placed in the lower back that uses a system similar to a pacemaker to regulate the nerves that control the bladder.

Tension-free suburethral sling is the most commonly used technique and consists of placing a tape that passes under the urethra to provide greater support during physical efforts. The tape bends the urethra when straining, like folding a running hose, thus preventing urine leakage (only those associated with physical effort).

Complications are minimal and include difficulty urinating, persistence of symptoms, or the tape not being properly covered by the vaginal mucosa.

The surgery is short and recovery is quick, so in most cases hospital admission is not required. It is recommended to avoid physical strain for 1 month to ensure proper integration of the mesh into the tissues beneath the urethra.

There are other less complex techniques that can be used, such as the injection of a gel into the urethra to coapt it (urethral bulking agents), or other techniques that do not involve prosthetic material.

The decision will be agreed upon between the patient and the specialized professional, taking into account the characteristics of the patient and the type of urinary incontinence she has.

Vaginal cones. Cone-shaped weights that are placed inside the vagina to tone the pelvic floor muscles. There are five cones of the same size but with different weights, ranging from 20 to 100 g.

Vaginal spheres. These are spherical devices with a weight in the centre; they are also placed inside the vagina to tone the pelvic floor muscles. They are available as a single sphere or a pair.

Tampons. It is a vaginal tampon that is inserted into the vagina to support the urethra and prevent urine leakage, without interfering with normal urination. They come in various sizes to better adapt to each woman’s vaginal capacity. They are hygienic, comfortable to wear, and reusable if properly cared for.

Incontinence pessary. These devices, available in different materials, shapes and sizes, are placed at the back of the vagina in order to maintain any fallen or prolapsed organs in their correct positions. Some of these devices are specifically designed for the treatment of urinary incontinence, with additional suburethral support. Your doctor or nurse will explain the hygiene measures, as well as how to insert and remove the pessary, so that you can gain maximum independence.

The pessary or vaginal tampon is indicated for women with stress urinary incontinence who cannot undergo surgery (due to contraindications, personal timing, while on a surgical waiting list, those who do not wish to have surgery, or those with occasional symptoms such as during exercise or colds).

They should not be used in cases of vaginal lesions or infections, during menstruation, or in the presence of pelvic inflammatory conditions.