See your doctor for an initial evaluation and to come up with a treatment plan. Treatment options vary, depending on the cause and type of incontinence you have. Fortunately, there are many things you can do to help manage incontinence.

The following methods are used to strengthen the muscles of your pelvic floor:

• Bladder retraining -- this involves urinating on a schedule, whether you feel a need to go or not. In between those times, you try to wait to the next scheduled time. At first, you may need to schedule 1 hour intervals. Gradually, you can increase by 1/2 hour intervals until you are only urinating every 3-4 hours without leakage.
• Kegel exercises -- contract the pelvic floor muscles for 10 seconds, then relax them for 10 seconds. Repeat 10 times. Do these exercises 3 times per day. You can do Kegel exercises any time, any place.

To find the pelvic muscles when you first start Kegel exercises, stop your urine flow midstream. The muscles needed to do this are your pelvic floor muscles. DO NOT contract your abdominal, thigh, or buttocks muscles. And DO NOT overdo the exercises. This may tire the muscles out and actually worsen incontinence.

Two methods called biofeedback and electrical stimulation can help you learn how to perform Kegel exercises. Biofeedback uses electrodes placed on the pelvic floor muscles, giving you feedback about when they are contracted and when they are not. Electrical stimulation uses low-voltage electric current to stimulate the pelvic floor muscles. It can be done at home or at a clinic for 20 minutes every 1 to 4 days.

Biofeedback and electrical stimulation will no longer be necessary once you have identified the pelvic floor muscles and mastered the exercises on your own.

Vaginal cones enhance the performance of Kegel exercises for women. Other devices for incontinence are also available.

For leakage, wear absorbent pads or undergarments. There are many well-designed products that go completely unnoticed by anyone but you.

Other measures include:

• Regulate your bowels to avoid constipation. Try increasing fiber in your diet.
• Quit smoking to reduce coughing and bladder irritation. Smoking also increases your risk of bladder cancer.
• Avoid alcohol and caffeinated beverages, particularly coffee, which can overstimulate your bladder.
• Lose weight if you need to.
• Avoid foods and drinks that may irritate your bladder like spicy foods, carbonated beverages, and citrus fruits and juices.
• Keep blood sugars under good control if you have diabetes.

Medications that may be prescribed include drugs that relax the bladder, increase bladder muscle tone, or strengthen the sphincter.

Surgery may be required to relieve an obstruction or deformity of the bladder neck and urethra. Uterine or pelvic suspension operations are sometimes needed in women. Men may require prostatectomy (removal of the prostate gland). Incontinence can sometimes be managed by artificial sphincters. These are synthetic cuffs that are surgically placed around the urethra to help retain urine.

If you have overflow incontinence or cannot empty your bladder completely, a catheter may be recommended. But using a catheter exposes you to potential infection.

PREVENTION

Performing Kegel exercises while you are pregnant and soon after delivery may help prevent incontinence related to childbirth.

Discuss incontinence with your doctor. Gynecologists and urologists are the specialists most familiar with this condition. They can evaluate the causes and recommend treatment approaches.

Call 911 or go to an emergency room if any of the following accompany a sudden loss of urine control:

• Difficulty talking, walking, or speaking
• Sudden weakness, numbness, or tingling in an arm or leg
• Loss of vision
• Loss of consciousness or confusion
• Loss of bowel control

Call your doctor if:

• You have been constipated for more than one week.
• You have difficulty starting your urine flow, dribbling, nighttime urination, pain or burning with urination, increased frequency or urgency, or cloudy or bloody urine.
• You are taking medications that may be causing incontinence. DO NOT adjust or stop any medications without talking to your doctor.
• You are over 60 years old and your incontinence is new, especially if you are also having trouble with your memory or caring for yourself.
• You have the urge to go often, but are only passing small amounts of urine.
• Your bladder feels full even after you have just urinated.
• Incontinence persists for more than 2 weeks even with exercises to strengthen your pelvic muscles.

• How long has incontinence been a problem for you?
• How many times does this happen each day?
• Are you aware of the need to urinate before you leak?
• Are you immediately aware that you have passed urine?
• Are you wet most of the day?
• Do you wear protective garments in case of accidents? How often?
• Do you avoid social situations in case of accidents?
• Have you had urinary tract infections in the past? Do you think that you may have one now?
• Is it more difficult to control your urine when you cough, sneeze, strain, or laugh?
• Is it more difficult to control your urine when running, jumping, or walking?
• Is your incontinence worse when sitting up or standing?
• Are you constipated? For how long?
• Is there anything you do to reduce or prevent accidents?
• Have you ever been treated for this condition before? Did it help?
• Have you tried pelvic floor exercises (Kegel)? Do they help?
• What procedures, surgeries, or injuries have you had?
• What medications do you take?
• Do you drink coffee? How much?
• Do you drink alcohol? How much?
• Do you smoke? How much each day?
• Do you have diabetes or a family history of diabetes?
• Do you have any other symptoms?

Diagnostic tests that may be performed include:

• Urinalysis
• Urine culture to check for infection if indicated
• Cystoscopy (inspection of the inside of the bladder)
• Urodynamic studies (tests to measure pressure and urine flow)
• Uroflow (to measure pattern of urine flow)
• Post void residual (PVR) to measure amount of urine left after urination