Behavioral changes (Conservative treatments) Some behavioral changes can improve<unk> . It is recommended to decrease overall consumption of liquids and avoid drinking caffeinated beverages because they irritate the bladder. Spicy foods, carbonated beverages, alcohol and citrus also irritate the bladder and should be avoided. Quitting smoking can also improve<unk>  because smoking irritates the bladder and can induce coughing (putting<unk>  on the bladder). The effectiveness of these approaches to treat people for whom synthetic midurethral tape surgery did not result in a cure (failed surgery) is not clear. Results of a 2019 systematic review of urinary incontinence in women found that most individual, active treatments are better than no treatment. Behavioral therapy, alone or combined with other interventions such as hormones, is generally more effective than other treatments alone. Exercises One of the most common treatment recommendations includes exercising the muscles of the pelvis. Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce<unk>  leakage. Patients younger than 60 years old benefit the most. The patient should do at least 24 daily contractions for at least 6 weeks. It is possible to assess pelvic floor muscle strength using a Kegel perineometer. Bladder training Bladder training is a technique that encourages people to modify their voiding habits (lengthening the time between voiding). Weak evidence suggests that bladder training may be helpful for the treatment of urinary incontinence. This type of intervention can take a person months to learn and would not be a therapy option for people who are not physically or mentally able to control their voiding. Incontinence pads An incontinence pad is a multi-layered, absorbent sheet that collects urine resulting from urinary incontinence.<unk> milar solutions include absorbent undergarments and adult diapers. Absorbent products may cause<unk> de effects of leaks, odors, skin breakdown, and UTI. Incontinence pads may also come in the form of a small sheet placed underneath a patient in the hospital, for<unk> tuations when it is not practical for the patient to wear a diaper. People have different preferences regarding the type of pad they use to stay dry when they have incontinence. In addition, the effectiveness of incontinence pads differ between people. Using different designs depending on the activity (sleeping/going out/staying in) is recommended. For men, the most cost-effective design is an incontinence pad in a diaper format. For women, incontinence pads that are in the form of disposable pull-ups are generally preferred, however there is a higher cost associated with this type of solution. For women who are in nursing homes, diapers are preferred at night. Washable diapers are cost effective, however, most people do not prefer washable diapers with the exception of some men who prefer as a means to control incontinence at night. There is no evidence that one type of incontinence pad is superior with regard to skin health. Pessaries A pessary is a medical device that is inserted into the vagina. The most common kind is ring shaped, and is typically recommended to correct vaginal prolapse. The pessary compresses the urethra against the symphysis pubis and elevates the bladder neck. For some women this may reduce<unk>  leakage, however it is not clear how well these mechanical devices help women with<unk>  urinary incontinence. Surgery Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success. Less-invasive variants of the sling operation have been shown to be equally effective in treating<unk>  as surgical sling operations. One such surgery is urethropexy. Insertion of a sling through the vagina (rather than by opening the lower abdomen) is called intravaginal slingplasty (IVS). Slings The procedure of choice for<unk>  urinary incontinence in females is what is called a sling procedure. A sling implant usually consists of a synthetic mesh material in the shape of a narrow ribbon but sometimes a biomaterial (bovine or porcine) or the patients own tissue that is placed under the urethra through one vaginal incision and two small abdominal incisions. The idea is to replace the deficient pelvic floor muscles and provide a backboard of support under the urethra. Transvaginal mesh has recently come under scrutiny due to controversy relating to the Food and Drug Administration. Initially, the FDA approved implantable mesh devices due to their<unk> milarity to earlier prototypes, known as the 510(k) process. As patients allege long-term harm and suffering as a result of implanted mesh; the FDA released a safety communication in 2008, and led to the reclassification of surgical mesh to a class 3 or high risk device in January 2016. Insertion of a sling through the vagina (rather than by opening the lower abdomen) is called intravaginal slingplasty (IVS). Transobturator tape The transobturator tape (TOT or Monarc) sling procedure aims to eliminate<unk>  urinary incontinence by providing support under the urethra. The minimally-invasive procedure eliminates retropubic needle passage and involves inserting a mesh tape under the urethra through three small incisions in the groin area. Midurethral tape A procedure that involves placing polypropylene tape under the outlet from the bladder to improve<unk> . Bladder repositioning Most<unk>  in women results from the urethra dropping down toward the vagina. Therefore, common surgery for<unk>  involves pulling the urethra up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the urethra and secures it with a string attached to muscle, ligament, or bone. For severe cases of<unk> , the surgeon may secure the urethra with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage. Peri/trans urethral injections A variety of materials have been historically used to add bulk to the urethra and thereby increase outlet resistance. This is most effective in patients with a relatively fixed urethra. Blood and fat have been used with limited success. The most widely used substance, gluteraldehyde crosslinked collagen (GAX collagen) proved to be of value in many patients. The main downfall was the need to repeat the procedure over time. Zephyr ZSI 375 Artificial Urinary Sphincter in a male patient Artificial urinary sphincter CT scan (coronal reconstruction) showing an artificial urethral sphincter in a woman Another procedure to treat incontinence is the use of an artificial urinary sphincter, more used in men than in women. In this procedure, the surgeon enters and wraps the cuff of the artificial urinary sphincter around the urethra, in the same manner a blood pressure cuff wraps around your arm. The device includes a pump implanted under the skin that, when pressed by the patient, loosens the cuff, allowing for free urination. After that, the artificial sphincter automatically regains its pressure, closing the urethra again, and providing proper continence. Acupuncture No useful studies have been done to determine whether acupuncture can help people with<unk>  urinary incontinence.
Stress incontinence
Overflow incontinence
Underactive bladder
Overactive bladder
Athletic incontinence
Neurogenic bladder dysfunction
Coital incontinence
Rectal prolapse