The treatment of incontinence is a step-wise process. Treatment starts with behavioral modification. Patients should urinate regularly according to a schedule. Also, the Kegel exercises can be helpful because they help to strengthen the pelvic muscles.
The next treatment step are the medications. Ditropan and Detrol are called anti-cholinergics and they relax the bladder muscle. Mirabegron is a B3 agonist that also relaxes the bladder. Finally, topical estrogen therapy can reduce urgency incontinence in post-menopausal women.
Two treatments that are effective for severe urgency incontinence are Electrical Stimulation and Botulinum toxin type A, or Botox. Dr. Lazare will discuss these therapies with you.
*Finally, for patients with severe stress urinary incontinence, the Mid Urethral Sling is a very safe and effective treatment. *The procedure is quick and performed on an outpatient basis. A small incision is made in the vagina just below the urethra. An artificial mesh is placed under the urethra which provides support. Risks include difficulty urinating which is usually temporary, and urinary urgency which is usually mild. Mesh erosion into the urethra or the bladder occurs in a small percentage of patients. *The long-term success rate of the sling is about 80%.
If the patient also suffers from descent of other pelvic structures such as the uterus or small bowel, anti-prolapse surgery can be performed at the same time.