Exercises

• Pelvic floor muscle training (PFMT), also called Kegel exercises.
  • These exercises involve squeezing and releasing the muscles that you use to stop urinating.
  • Your doctor can tell you how many times you should squeeze and release and how long you will need to keep doing these exercises.
  • PFMT is sometimes done with biofeedback to help women learn how to do the exercises. Biofeedback uses electronic recorders or other instruments, and sometimes written diaries, to record contractions of your pelvic floor muscles or bladder muscles.

Bladder training

• This method involves building up the ability to hold your urine for longer and longer periods by following a schedule.
• The goal is to have a schedule that has you go only once every 3 or 4 hours.
• Even if you don't feel the need to urinate, you empty your bladder on the planned schedule.
• Every time you feel the urge to urinate outside of that schedule, you try and hold it for more and more minutes each time until you can keep to your schedule.
• Your doctor can help you set a schedule based on your own body.

Medical devices

• Electric stimulation
  • A soft, silicone rubber tube about the size of a tampon is inserted into the vagina. It is attached to a battery-operated unit that sends a small amount of electricity into the tube and the muscles surrounding it.
  • This therapy can be done at home after a therapist or nurse explains how to use the device and sets a level that tightens the muscles but is still comfortable.
• Magnetic stimulation
  • The patient sits down on a chair that has magnetic coils in the seat or under the seat. An electric current is sent into the coil, creating a magnetic field that tenses and relaxes the muscles of the pelvis.
  • This therapy must be done in a doctor's office or clinic. The patient can remain clothed during therapy.
• Percutaneous tibial nerve stimulation (PTNS)
  • PTNS uses a fine needle that is inserted near the ankle.
  • Pulses of electricity are sent into the needle to travel through the tibial nerve, a nerve that runs up your leg and connects to nerves that control your bladder muscles.
  • This therapy must be done in a doctor's office or clinic.

Medicine

Doctors can use several different kinds of medicines to help improve UI, depending on the kind of UI you have.

What does the research say about treatments for UI?

How do I make sense of this information?

This chart shows the research on how likely a treatment for stress or urgency incontinence may work to improve symptoms or make someone continent. The women in green will have the benefit, the women in red are the ones who will have the side effect, and the women in blue are those who will not have either a benefit or a side effect. For example:

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	5 out of 10 women means that the chances are about 50/50 that you will see the same result.
	1 out of 10 women means that you have a smaller chance to see the same result.

The higher the number of women out of 10 that saw a result, the more likely you are to see the same result.

These are general estimates of how likely a treatment may work or cause a side effect. Every person may respond differently. You may need to try several treatments before finding what works for you.

Non-medicine Options for Treating Stress Incontinence

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Non-drug Treatments: Exercises
Pelvic floor muscle training (PFMT)	Benefits 3 out of 10 women became continent using this treatment. 4 out of 10 women improved their symptoms using this treatment. Side Effects Not known, but most researchers think there are few if any.
PFMT with biofeedback	Benefits 4 to 5 out of 10 women became continent using this treatment but more research could change this finding. 4 out of 10 women improved their symptoms using this treatment. Side Effects Not known, but most researchers think there are few if any.
Non-drug Treatments: Medical Devices
Electric stimulation	Benefits 2 out of 10 women became continent using this treatment. 2 out of 10 women improved their symptoms using this treatment. Side Effects Not known, but most researchers think there are few if any.
Magnetic stimulation	Benefits Did not help women become continent, but more research could change this finding. 3 out of 10 women improved their symptoms using this treatment, but research is limited. Side Effects Not known, but most researchers think there are few if any.
Medicines for Treating Stress Incontinence
Topical estrogen	Benefits There is not enough research to know if estrogen helped UI. Side Effects There is not enough research to know if estrogen taken for UI causes side effects.
Duloxetine (Cymbalta®)	Benefits Less than 1 out of 10 women improved their symptoms using this medicine. Side Effects About 2 in 10 women had nausea using this medicine. 1 in 10 women had dry mouth using this medicine. About ½ to 1 out of 10 women had constipation, extreme sleepiness, insomnia (inability to fall asleep or stay asleep), and dizziness using this medicine.

Options for Treating Urgency Incontinence

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Non-drug Treatments: Lifestyle Changes
Bladder training	Benefits The number of women who became continent was not reported. 4 out of 10 women improved their symptoms using bladder-control exercises. Combining PFMT with bladder training improved continence in women with urgency incontinence. Side Effects Not known, but most researchers think there are few if any.
Non-drug Treatments: Medical Devices
Percutaneous tibial nerve stimulation	Benefits The number of women who became continent was not reported. 3 out of 10 women improved their symptoms using this device. Side Effects There were no differences in the number of women who reported side effects from using this device than those who reported side effects from using a “sham” treatment (no electrical pulse was given, but women were told they were getting the treatment).
Medicines for Treating Urgency Incontinence
Darifenacin (Enablex®)	Benefits About 1 out of 10 women improved their symptoms using this medicine. Side Effects About 2 out of 10 women had dry mouth using this medicine. About 1 out of 10 women had constipation using this medicine. Less than 1 out of 10 women had an upset stomach using this medicine.
Fesoterodine (Toviaz®)	Benefits About 1 out of 10 women became continent using this medicine. About 1 out of 10 women improved their symptoms using this medicine. Side Effects About 2 out of 10 women had dry mouth using this medicine. Less than 1 out of 10 women had constipation using this medicine. Less than 1 out of 10 women had dry eyes using this medicine.
Oxybutynin (Ditropan®)	Benefits About 1 out of 10 women became continent using this medicine. About 2 out of 10 women improved their symptoms using this medicine. Side Effects About 3 to 4 out of 10 women had dry mouth using this medicine. About 1 out of 10 women had an upset stomach using this medicine. Constipation: No different from women taking a placebo (sugar pill).
Solifenacin (VESIcare®)	Benefits About 1 out of 10 women became continent using this medicine. About 2 out of 10 women improved their symptoms using this medicine. Side Effects About 1 to 2 out of 10 women had dry mouth using this medicine. About 1 out of 10 women had constipation using this medicine. Less than 1 out of 10 women had blurred vision using this medicine.
Tolterodine (Detrol®)	Benefits About 1 out of 10 women became continent using this medicine. About 1 out of 10 women improved their symptoms using this medicine. Side Effects About 1 out of 10 women had dry mouth using this medicine. Less than 1 out of 10 women had constipation using this medicine. Less than 1 out of 10 women had upset stomach using this medicine.
Trospium (Sanctura®)	Benefits About 1 out of 10 women became continent using this medicine. Side Effects About 1 out of 10 women had dry mouth using this medicine. Less than 1 out 10 women had constipation using this medicine. Less than 1 out of 10 women had dry eyes using this medicine.

How do UI medicines compare with one another?

• Fesoterodine is better than tolterodine at decreasing the strength and number of urges to urinate, but it might also be more likely to cause negative side effects than tolterodine. Fesoterodine might also be better at completely stopping any leaking, but there wasn't enough research to know for sure.
• Oxybutynin was not better at preventing any leaking than tolterodine, but it might be more likely to cause negative side effects than tolterodine.
• There isn't enough research to say for sure how medicines that are taken together compare with medicines taken alone.
• More than half of all people taking medicines for UI stop taking them after 1 year of treatment, usually because of side effects.
• Oxybutynin (Ditropan^®), trospium (Sanctura^®), and darifenacin (Enablex^®) work in women of all ages, including those 65 years of age and older.
• Trospium (Sanctura^®) works in women who are obese (very overweight). There is not enough research to know how being very overweight affects other medicines.
• If you are taking seven or more medicines (of any kind) at the same time, you are more likely to have side effects from trospium (Sanctura^®).
• Solifenacin (VESIcare^®) is likely to work even if you have not had benefits from other medicines.
• Higher doses of medicine are effective for people who do not see results the first time they try a medicine except for solifenacin (VESIcare^®), but higher doses also increase the chances for having side effects.

Comparing exercises with devices and medicines

No research studies compared the results of exercises with devices and with medicines. However, exercises and medical devices seem to have better results for improving UI symptoms and helping women become continent than do medicines, with fewer negative side effects.

Lifestyle changes

Some research that found women who are very overweight were able to improve their UI symptoms by losing weight and exercising.

Managing UI symptoms

While you are treating UI, you can manage incontinence by:

• Scheduling regular bathroom breaks.
• Requesting that you be allowed to work close to a bathroom.
• Wearing pads inside your underwear.

How long will I need to use the treatments?

You may need to use treatments even after your UI improves, and even if it goes away completely.

What are the costs of treatment?

The costs to you for treatment depends on a number of factors, including:

• Your health insurance plan. Some stimulation devices may not be covered by Medicare, Medicaid, or private insurance companies. Your medicine co-pay will also depend on your drug plan.
• Exercise and bladder training may not cost anything unless you work with a nurse or physical therapist.
• The length of time you need to use medical devices or medicine.
• The amount (dose) of medicine you need to take.
• Whether the medicine comes in a generic form. Most UI medicines do not come in generic form.

Ask your doctor

• What do you think about the research on different UI treatments?
• Given my UI symptoms, which of these options is most likely to work for me?
• How long will it take to see a difference, and when do I see you to try something different?
• How will I know if I am having a serious side effect from the medicine, and when should I call you?

Write the answers here

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