Treatment Options for Female Incontinence

When you make an appointment for an evaluation at Virginia Mason's Pelvic Floor Center, in Seattle, you will be given the personalized attention you deserve from every member of our expertly trained staff. We believe that there is an appropriate treatment for every patient and that you are a true partner in managing your condition. We dedicate time to discussing all of your options and offer suggestions for steps you can take to enjoy an active, unrestricted life.

Our state-of-the-art video urodynamics lab provides us with simultaneous electronic tracings of bladder activity and video imaging of the bladder in motion. Both are important to determine the cause and type of incontinence you may be experiencing. Our specialists all have particular expertise in interpreting this data. For more information about treatment options for female incontinence, call the Pelvic Floor Center at (206) 223-6772.

Based on the type of incontinence you have, we will then discuss several treatment options with you. Learn more about the treatment options available:

Stess Incontinence Treatments

Urge Incontinence Treatments

Stress Incontinence Treatments

Non-surgical Options
You and your physician will first consider non-surgical treatments, if appropriate for your condition.

  • Education - Two very good books we recommend to learn more about your condition are Staying Dry: A Practical Guide to Bladder Control and Overcoming Overactive Bladder, both available at our front desk.
     
  • Physical Therapy - Often, the quickest and most successful method to gain awareness and strengthen the pelvic floor muscles is to work with a trained nurse clinician or physical therapist. These individuals have the skills and training required to assess the problem and teach techniques for correcting problems, often in two to four visits.
     
    Physical therapy starts with moderate aerobic activity and includes pelvic floor muscle exercises. For the patient unable to isolate pelvic floor muscles, we offer the biofeedback program as a learning tool. The biofeedback program includes the expertise of a personal trainer and office and home based equipment to help you learn to contract the right muscles to regain continence.
     
  • Incontinence Aids
    A variety of shields and other incontinence aids that women can insert themselves are now available. They are simple non-surgical solutions, but require consistency and a certain amount of dexterity. Some of the more popular aids include: 
     
    • Urethral Insert - The urethral insert we commonly use at the Pelvic Floor Center, Fem Soft®, blocks the urethra with a small balloon. You simply insert the device, and then remove the device to void.
       
    • Pessary - The pessary has been used successfully in the treatment of pelvic floor prolapse for decades. It is a device inserted into the vagina to provide support to correct vaginal prolapse — and that may help maintain continence.
       
    • Pads - Pads continue to be improved and refined. The newer gel-type pads have the ability to wick wetness away from the skin.
       
    • Indwelling Bladder Catheters - A flexible plastic tube (catheter) inserted into the bladder, provides continuous urinary drainage. Because it remains in place ("dwells") this common type of indwelling bladder catheter has a balloon on the bladder end. After the catheter is inserted in the bladder, the balloon is inflated (with air or fluid) so that the catheter cannot be pulled out inadvertently. Removal is accomplished simply by deflating the balloon and slipping the catheter out.

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Surgical Options

  • Injection Therapy - Injection therapy involves injecting a small amount of collagen or a synthetic material just beneath the lining of the urethra to restore continence by bulking up and tightening the valve muscle.

    This procedure takes about 10 minutes and requires a local anesthetic. The results are immediate and the risks are very slight. Most patients will require repeat injections every six to nine months.
     
  • Slings - Sling procedures have become the mainstay of surgical treatment for all types of stress urinary incontinence. This technique involves placing a supporting hammock or "sling" beneath the urethra. When a patient coughs or strains, the bladder neck and urethra are pushed down into the sling, which serves as a backstop, and helps close the urethra, thereby preventing leakage. A range of distinct sling procedures are available at Virginia Mason, each tailored specifically to the individual.

    Virginia Mason urologists have been on the leading edge of advancement in sling techniques since 1993 and have become national leaders in the field, helping to develop new and less-invasive methods to permanently support the urethra and bladder.

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Urge Incontinence Treatments

Non-surgical Options

  • Education - Two very good books we recommend to learn more about your condition are Staying Dry: A Practical Guide to Bladder Control and Overcoming Overactive Bladder, both available at our front desk.
     
  • Dietary Changes - Dietary and social habits can play an important role in bladder instability and urge incontinence. Many patients are surprised to learn that inadequate fluid intake can result in concentrated urine that may increase bladder irritation and result in increased urinary frequency. Conversely, excess fluid intake can exacerbate urinary frequency in many patients. There are also a number of foods that increase urgency, including acidic and spicy foods, caffeine, soda pop, artificial sweeteners and alcohol. Keeping a diary of both your frequency of urination and a food diary can identify and help eliminate foods that cause urgency.
     
  • Habit Changes - The most common bladder irritants are cigarettes and caffeine. Chronic coughing, smoking, and excessive weight are also all potentially reversible problems that can reduce pressure on the pelvic floor. Bowel problems, such as constipation and irritable bowel syndrome, are also important to address and correct as they influence pelvic floor function.
     
  • Bladder Training Techniques - If appropriate, we can teach you bladder retraining techniques, which enable many people to learn to delay urination and suppress urge symptoms. These can be extremely helpful in reversing frequent urination and any associated incontinence.
     
  • Medications - Depending on your case, your physician may prescribe one or more medications to aid or correct incontinence. These medications range from vaginal creams, which provide estrogen support, to antispasmodics to treat bladder overactivity.
     
  • Image: female neuromodulationNeuromodulation - Neuromodulation can be performed as a temporary procedure by stimulating the tibial nerve in the ankle, similar to acupuncture. The tibial nerve originates from the same nerve root (S3) that gives the bowel and bladder function. This is the same nerve we aim to stimulate with the Interstim. The temporary stimulation method is applied once or twice a month in the clinic or by the patient at home.

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Surgical Treatment Options

  • Botox Treatments - BotoxTM is now being used on an experimental basis to relax the muscles that cause the bladder to contract. The effects of Botox therapy typically last nine to 12 months, and about 60 percent of patients experience some improvement in their incontinence. However, the U.S. Food and Drug Administration (FDA) have not yet approved Botox for use in the bladder, and it's not considered a permanent treatment.
     
  • Neuromodulation - One of the newest and most promising treatments for urge urinary incontinence is neuromodulation, which can be thought of as a "pacemaker" for the bladder. Neuromodulation is used in patients with urge incontinence when other therapies have not worked well.
     
    The FDA approved another means of neuromodulation, InterStimTM, in 1998. It involves placing permanent electrodes near the bladder nerves as they exit the spinal cord. The nerves are stimulated continuously by a small device placed under the skin in the patient's back. At the Pelvic Floor Center, we are seeing encouraging results in patients who are well-suited for this procedure.
     
  • Bladder Enlargement (Augmentation) - This procedure is an option for patients with urge incontinence who have not found success with other treatments, such as medications, bladder training, behavioral modification and nerve stimulation.
     
    This bladder-enlarging surgery is performed in the operating room under a general anesthetic, with recovery in the hospital taking an average of seven to 10 days. Virginia Mason is one of the few medical centers in the United States that performs this surgery laparoscopically.

For more information about treatment options for female incontinence, call the Pelvic Floor Center at (206) 223-6772.

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