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Treatment for Urinary Incontinence

Urethral Plugs and Pessaries
Certain devices for women with stress incontinence are urethral "plugs" and pessaries. A woman inserts a plug into the urethra, where it seals off the flow of urine. It is removed during routine urination, disposed of, and replaced with a new one as needed.
 
Pessaries are synthetic or rubber devices of various shapes intended to occupy space within the vagina. A health professional fits and inserts a pessary into the vagina, where it helps support the pelvic organs to reduce leakage.
 
Women who use urethral inserts and pessaries for treating urinary incontinence need to watch for possible urinary tract and vaginal infections.
 
Clamps and Compression Rings
Devices for men include clamps and compression rings that fit over the penis to squeeze the urethra shut. These must be removed to empty the bladder. Possible side effects can include pain and tissue erosion when these devices are not used properly.
 

Urinary Incontinence Treatment With Implanted Devices or Surgery

When other options to treat urinary incontinence have failed, implanted devices or surgery may be effective.
 
Collagen
In a 30-minute outpatient procedure, a thick substance made of collagen, carbon-coated beads, or other particles suspended in a solution can be injected into the area surrounding the opening to the bladder. The substance, called a bulking agent, helps close the bladder opening to prevent leakage.
 
Bulking agents are approved to treat stress incontinence due to poorly functioning sphincter muscles. The collagen device is approved for both women and men; others are approved only for women.
 
Repeated injections of bulking agents may be needed because the body slowly eliminates the substance over time. Potential side effects include:
 
  • Urinary tract infections
  • Delayed ability to urinate
  • Painful urination
  • Urgency
  • Frequent urination
  • Blood in the urine.
     
Bladder Pacemaker
When men or women with an overactive bladder have failed to respond to more conservative treatments, an electrical stimulation device can be placed next to the tailbone.
 
This treatment for urinary incontinence requires a trial period in which a doctor surgically implants a temporary electrode in the lower back. This is attached by a thin wire, called a lead, to an external stimulation device, which patients carry with them for a few days. The device sends mild electrical pulses to the nerve that controls the bladder and surrounding muscles.
 
If there is dramatic improvement, the device is then permanently implanted at a second outpatient surgery, leaving all hardware under the skin.
 
In clinical studies, more than one-third of patients did not receive the implanted device, usually because they did not have significant improvement during the trial period.
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