Non-surgical treatment - Urinary incontinence

Your treatment will depend on the type of urinary incontinence you have and the severity of your symptoms.

If urinary incontinence is caused by an underlying condition, you may receive treatment for this alongside incontinence treatment.

Conservative treatments, which do not involve medicines or surgery, are tried first. These include:

• lifestyle changes
• pelvic floor muscle training (Kegel exercises)
• bladder training

After this, medicine or surgery may be considered.

This page is about non-surgical treatments for urinary incontinence. Find out about surgery and procedures for urinary incontinence.

Lifestyle changes

A GP may suggest you make simple changes to your lifestyle to improve your symptoms, regardless of the type of urinary incontinence you have.

For example, the GP may recommend:

• reducing your intake of caffeine, which is found in tea, coffee and cola, as caffeine can increase the amount of urine your body makes
• altering how much fluid you drink each day, as drinking too much or too little can make incontinence worse
• losing weight if you are overweight or obese – use the healthy weight calculator to find out if you're a healthy weight for your height

NHS continence services

NHS continence services are centres staffed by specialist nurses, sometimes called continence advisers, and specialist physiotherapists. They should be able to diagnose your condition and start treating you.

A GP can refer you to your local continence service and in some cases you may be able to refer yourself.

Pelvic floor muscle training

Your pelvic floor muscles surround the bladder and urethra (the tube that carries urine from your bladder out of your body) and control the flow of urine as you pee.

Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.

A GP may refer you to a specialist to start a programme of pelvic floor muscle training.

The specialist will assess whether you're able to squeeze (contract) your pelvic floor muscles and by how much.

If you can contract your pelvic floor muscles, you'll be given an exercise programme based on your assessment.

Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.

Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.

Find out more about pelvic floor exercises.

Electrical stimulation

If you're unable to contract your pelvic floor muscles, using electrical stimulation may be recommended.

A small probe will be inserted into the vagina, or into the anus (if you have a penis). An electrical current runs through the probe, which helps strengthen your pelvic floor muscles while you exercise them.

You may find electrical stimulation difficult or unpleasant, but it may be beneficial if you're unable to complete pelvic floor muscle contractions without it.

Biofeedback

Biofeedback is a way to monitor how well you do pelvic floor exercises by giving you feedback as you do them.

There are several different methods of biofeedback:

• a small probe could be inserted into the vagina, or the anus (if you have a penis), which senses when the muscles are squeezed and sends the information to a computer screen
• electrodes could be attached to the skin of your tummy (abdomen) or around the anus – these sense when the muscles are squeezed and send the information to a computer screen

There is not much good evidence to suggest biofeedback offers a significant benefit to people using pelvic floor muscle training for urinary incontinence, but the feedback may help motivate some people to do their exercises.

Speak to your specialist if you would like to try biofeedback.

Vaginal cones

Vaginal cones may be used to assist with pelvic floor muscle training. These small weights are inserted into the vagina.

You hold the weights in place using your pelvic floor muscles. When you can, you progress to the next vaginal cone, which weighs more.

Some women find vaginal cones uncomfortable or unpleasant to use, but they may help with stress or mixed urinary incontinence.

Bladder training

If you've been diagnosed with urge incontinence, one of the first treatments you may be offered is bladder training.

Bladder training may also be combined with pelvic floor muscle training if you have mixed urinary incontinence.

It involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. The course will usually last for at least 6 weeks.

Incontinence products

While incontinence products are not a treatment for urinary incontinence, you might find them useful for managing your condition while you're waiting to be assessed or waiting for treatment to start helping.

Incontinence products include:

• absorbent products, such as pants or pads
• handheld urinals
• a catheter (a thin tube that is inserted into your bladder to drain urine)
• devices that are placed into the vagina or urethra to prevent urine leakage – for example, while you exercise

Find out more about incontinence products, and information about getting free incontinence products on the NHS.

Medicine for stress incontinence

If stress incontinence does not significantly improve with lifestyle changes or exercises, surgery will usually be recommended as the next step.

However, if you're unsuitable for surgery or want to avoid an operation, you may benefit from an antidepressant medicine called duloxetine. This can help increase the muscle tone of the urethra, to help keep it closed.

You'll need to take duloxetine tablets twice a day and will be assessed after 2 to 4 weeks to see if the medicine is beneficial or causing any side effects.

Possible side effects of duloxetine can include:

• nausea
• dry mouth
• extreme tiredness (fatigue)
• constipation

Do not suddenly stop taking duloxetine, as this can also cause unpleasant side effects. A GP will reduce your dose gradually.

Duloxetine is not suitable for everyone, however, so a GP will discuss any other medical conditions you have to determine if you can take it.

Medicines for urge incontinence

Antimuscarinics (anticholinergics)

If bladder training is not effective for your urge incontinence, a GP may prescribe a medicine called an antimuscarinic, also called an anticholinergic.

Antimuscarinics may also be prescribed if you have overactive bladder syndrome, which is the frequent urge to urinate that can happen with or without urinary incontinence.

The most common types of antimuscarinic medicines used to treat urge incontinence include:

• oxybutynin
• tolterodine
• darifenacin

These are usually taken as a tablet that you swallow, 2 or 3 times a day, although oxybutynin also comes as a patch that you place on your skin twice a week.

You will usually start taking a low dose to minimise any possible side effects. The dose can be increased until the medicine is effective.

Possible side effects of antimuscarinics include:

• dry mouth
• constipation
• blurred vision
• extreme tiredness (fatigue)

In rare cases, antimuscarinics can lead to a build-up of pressure within the eye (glaucoma), called angle closure glaucoma.

You'll be assessed after 4 weeks to see if the medicine is helping, and every 6 to 12 months thereafter if the medicine continues to be effective.

A GP will discuss any other medical conditions you have to determine which antimuscarinic is suitable for you.

Mirabegron

If antimuscarinics are unsuitable for you, they have not helped urge incontinence, or have unpleasant side effects, you may be offered an alternative medicine called mirabegron.

Mirabegron causes the bladder muscle to relax, which helps the bladder fill up with and store urine. It usually comes as a tablet or capsule that you swallow once a day.

Side effects of mirabegron can include:

• urinary tract infections (UTIs)
• a fast or irregular heartbeat
• suddenly noticeable heartbeats (palpitations)
• a rash
• itchy skin

The GP will discuss any other medical conditions you have to determine whether mirabegron is suitable for you.

Medicine for nocturia

A low-dose version of a medicine called desmopressin may be used to treat nocturia, which is the frequent need to get up during the night to urinate, by helping to reduce the amount of urine produced by the kidneys.

Another type of medicine taken late in the afternoon, called a loop diuretic, may also prevent you getting up in the night to pass urine.

Diuretic medicine increases the production and flow of urine from your body. By removing excess fluid from your body in the afternoon, it may improve symptoms at night.

Loop diuretics are not licensed to treat nocturia. This means the medicine may not have undergone clinical trials to see if it's effective and safe in the treatment of nocturia.

However, a GP or specialist may suggest an unlicensed medicine if they think it's likely to be effective and the benefits of treatment outweigh any associated risk.

If a GP is considering prescribing a loop diuretic, they should tell you it's unlicensed and discuss the possible risks and benefits with you.