Urinary Incontinence Treatment

Reading time: 10 min

Some women who experience urinary incontinence sometimes disregard it because it only happens very occasionally, in very small quantities or it doesn’t interfere with their well-being, and so they don’t need to visit a doctor or receive any treatment. Contrastingly, in other women, urinary incontinence is detrimental and they need to be aware of the treatment options available for each type of incontinence.

A high percentage of women with urinary incontinence who receive personalised treatment indicated by specialists manage to cure or significantly improve their symptoms.

There are several treatments for urinary incontinence. Treatment selection, which may involve a single therapy or a combination, is based on each patient’s characteristics, type of symptoms and the severity of their incontinence.

Conservative treatment includes a set of measures that do not involve surgery or taking medication. It is recommended for all women with urinary incontinence, regardless of the type they have, as these measures are beneficial for both types.

Scale with a down arrow indicating a weight loss

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.

Carrot, broccoli and courgette

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.

Cigarette crossed out on a "no smoking" poster

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.

Mug with hot drink crossed out

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.

Crossed-out water bottle

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.

Sweating woman carrying two bags

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.

Woman training pelvic muscles with a pilates ball

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.

Vaginal cones or spheres

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. 

Pharmacological treatment is useful for women diagnosed with overactive bladder, with or without associated urgency urinary incontinence. Currently, several medications are available that reduce involuntary bladder spasms and relax the muscle responsible for contraction. However, some of these medications are contraindicated in patients with glaucoma, pyloric stenosis, severe bronchospasm, reflux esophagitis, intestinal ileus, and severe ulcerative colitis, as well as in those with uncontrolled high blood pressure. After starting pharmacological treatment, a follow-up visit is recommended around four weeks later to assess the treatment’s effectiveness. If there is an improvement in symptoms (such as fewer urgency episodes and leaks), the medication is continued long-term; if not, or if the improvement is minimal, the dose may be adjusted or a different drug from another group may be tried.

The symptoms of urgency urinary incontinence do not always improve with drug therapies. In these cases the possibility of administering second-line treatments in specialised units is evaluated. These include:

Syringe

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 nerve stimulation

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.

Stress incontinence

This type of treatment is indicated in women with moderate or severe stress urinary incontinence who do not wish to follow conservative treatment or for whom it has proven ineffective.

The choice of surgical technique to correct the symptoms of stress incontinence is currently based on each patient’s characteristics and the experience of the surgical team that will perform the operation.

Tension-free vaginal band for urinary incontinence

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.

The technique has minimal complications and recovery is quick; the majority of cases do not require an overnight hospital stay.

There are other simpler techniques that can be used when individuals do not respond to the standard technique or when the specialist considers another method more appropriate given the patient’s characteristics.

Mixed incontinence

The treatment of these cases is complex and requires a very high degree of personalisation as well as a very complete study.

The specialist will evaluate the characteristics of each individual and the severity of their symptoms. This assessment is used to decide whether to treat the symptoms of the urge or stress type incontinence first. Alternatively, sometimes both sets of symptoms are treated from the beginning.

There are various devices available to help tone the pelvic floor muscles, which can be used at home:

Vaginal cones

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 cones or spheres

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.

There are vaginal devices that compress the urethra from within the vagina, increasing support while in use, and are useful for temporarily relieving symptoms of stress urinary incontinence. These devices include the vaginal tampon and the incontinence pessary.

Vaginal tampon

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.

Urethral pessary

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.

Genital atrophy is a condition mainly caused by the decrease in female sex hormones (estrogens) during menopause. It involves the thinning of the walls of the vagina and vulva, along with a reduction in vaginal lubrication, leading to symptoms such as vaginal dryness, genital irritation, and/or discomfort during sexual intercourse.

Genital atrophy can worsen symptoms of overactive bladder, with or without urgency urinary incontinence, due to the presence of estrogen receptors also in the urethra and bladder. To improve this situation, it is recommended to apply local treatment (to the vulva and vagina) with estrogens in the form of creams, suppositories, or vaginal tablets. It is recommended to use them 2–3 nights per week.

Hence postmenopausal women with urge incontinence are indicated the appropriate vaginal oestrogens in function of their drug therapy, as long as there are no contraindications (e.g., women with a history of breast cancer, etc.), in which case vaginal moisturisers may be indicated.

Substantiated information by:

Amelia Pérez González
Montserrat Espuña Pons
Sònia Anglès Acedo

Published: 20 February 2018
Updated: 17 July 2025

The donations that can be done through this webpage are exclusively for the benefit of Hospital Clínic of Barcelona through Fundació Clínic per a la Recerca Biomèdica and not for BBVA Foundation, entity that collaborates with the project of PortalClínic.

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