Conservative measures for treating urinary incontinence should be tried first. These include:

Lifestyle changes

Some simple changes to lifestyle can help to reduce incontinence. For example:

  • reducing caffeine intake. Caffeine is found in tea, coffee and cola and can increase the amount of urine that the body produces.
  • drinking 1-1.5 litres (six to eight glasses) of fluid a day. Drinking too much or too little can cause symptoms that affect the lower urinary tract (bladder and urethra).
  • losing weight, if the patient is overweight or obese.

Pelvic floor muscle training

The pelvic floor muscles are those used to control the flow of urine during urination. They surround the bladder and urethra (the tube that carries urine from the bladder to outside the body).

Weak or damaged pelvic floor muscles can cause urinary incontinence, so strengthening these muscles through exercise is often one of the first treatments recommended, whether the patient has stress, urge or mixed incontinence.

Bladder training

If the patient has been diagnosed with urge incontinence, one of the first treatments usually offered is bladder training. Bladder training may also be combined with pelvic floor muscle training, if the patient has stress incontinence or mixed urinary incontinence.

Bladder training involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. The course usually lasts for at least six weeks.

Medication for urge incontinence

If bladder retraining alone does not produce sufficient improvement, then medication called anticholinergics can be tried. The commonly used preparations are: solifenacin, tolterodine oxybutynin and fesoterodine. They work by blocking certain nerve impulses to the bladder, which 'relaxes' the bladder muscle and so increases its capacity.

Medication improves symptoms in some cases, but not all. The amount of improvement varies from person to person. There may be fewer toilet trips, fewer urine leaks, and less urgency. However, it is uncommon for these symptoms to disappear completely with medication alone. A common plan is to try a course of medication for a month or so. If this is helpful, the patient may be advised to continue for up to six months and then stop the medication, to see how symptoms are without medication. The symptoms may return after finishing a course of medication. However, if a course of medication is combined with bladder training, the long-term outlook is often better and the symptoms are less likely to return when medication is stopped.

Side-effects are quite common with these medicines, but are often minor and tolerable. The most common is a dry mouth, and simply having frequent sips of water may counter this. Other side-effects can include dry eyes, constipation and blurred vision. However, there are differences between these medicines and an individual patient may find that, if one medicine causes troublesome side-effects, switching to an alternative one may suit better.

Hormonal preparations

For women after the menopause, topical treatment with oestrogen (via a pessary or cream) may have a positive effect on incontinence. This is used in women who have vaginal atrophy, a condition that caused by lack of oestrogen, leading to vaginal dryness, itching or discomfort. The urgent and frequent need to pass urine, may also be a symptom of vaginal atrophy. Therefore, treating vaginal atrophy with oestrogen cream can sometimes relieve these symptoms.

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