Incontinence, urinary - Non-surgical treatments for urinary incontinence

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

If your incontinence is caused by an underlying condition, such as an enlarged prostate gland in men, you may receive treatment for this alongside your incontinence treatment.

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

• lifestyle changes
• pelvic floor muscle training
• bladder training

After this, medication or surgery may be considered.

This page is about non-surgical treatments for urinary incontinence. There is a separate page on surgery and procedures for urinary incontinence.

Read on to learn about the different treatments you may be offered. You can also read a summary of the pros and cons of these treatment options, allowing you to compare your treatment options.

Lifestyle changes

Your GP may suggest you make simple changes to your lifestyle to improve your symptoms. These changes can help improve your condition, regardless of the type of urinary incontinence you have.

For example, your GP may recommend:

• reducing your caffeine intake – caffeine is found in tea, coffee and cola and can increase the amount of urine your body produces
• altering how much fluid you drink a day – 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 are a healthy weight for your height

Pelvic floor muscle training

Your pelvic floor muscles are the muscles you use to control the flow of urine as you urinate. 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 exercising these muscles is often recommended.

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

Your specialist will assess whether you are able to squeeze (contract) your pelvic floor muscles and by how much. If you can contract your pelvic floor muscles, you will be given an individual exercise programme based on your assessment.

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

Research suggests that women who complete pelvic floor muscle training experience fewer leaking episodes and report a better quality of life.

In men, some studies have shown that pelvic floor muscle training can reduce urinary incontinence – particularly after surgery to remove the prostate gland.

The British Association of Urological Surgeons (BAUS) has more information on pelvic floor exercises in women (PDF, 163kb) and pelvic floor exercises in men (PDF, 174kb).

Electrical stimulation

If you are unable to contract your pelvic floor muscles, using a device that measures and stimulates the electrical signals in the muscles may be recommended. This is called electrical stimulation.

A small probe will be inserted into the vagina in women or the anus in men. An electrical current runs through the probe, which helps to strengthen your pelvic floor muscles while you exercise them.

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

Biofeedback

Biofeedback is a way to monitor how well you are doing the 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 in women or the anus in men – this senses when the muscles are squeezed and sends the information to a computer screen
• electrodes (sticky electrical patches) could be attached to the skin of your abdomen or around the anus – these sense when the muscles are squeezed and send the information to a computer screen

There isn't 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 carry out their exercises.

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

Vaginal cones

Vaginal cones may be used by women to assist with pelvic floor muscle training. These are small weights that 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 have 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.

Bladder training 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 six weeks.

Incontinence products

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

Incontinence products include:

• absorbent products, such as incontinence pants or pads
• hand-held urinals (urine collection bottles)
• 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

For more information, see can I get incontinence products on the NHS?

Medication for stress incontinence

If stress incontinence does not significantly improve, surgery for urinary incontinence will often be recommended as the next step.

However, if you are unsuitable for surgery or you want to avoid having an operation, you may benefit from a medication called duloxetine. This can help increase the muscle tone of the urethra, which should help keep it closed.

You will need to take duloxetine by mouth twice a day and will be assessed after two to four weeks to see if the medicine is beneficial or if it is causing any side effects.

Possible side effects of duloxetine can include:

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

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

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

Medication for urge incontinence

Antimuscarinics

If bladder training is not an effective treatment for your urge incontinence, your GP may prescribe a type of medication called an antimuscarinic.

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

A number of different antimuscarinic medications that can be used to treat urge incontinence, but common ones include oxybutynin, tolterodine and darifenacin.

These are usually taken by mouth two or three times a day, although an oxybutynin patch that you place on your skin twice a week is also available.

Your GP will usually start you at a low dose to minimise any possible side effects. The dose can then be increased until the medicine is effective.

Possible side effects of antimuscarinics include:

• dry mouth
• constipation
• blurred vision
• fatigue

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

You will be assessed after four weeks to see how you are getting on with the medication, and every six to 12 months thereafter if the medication continues to help. 

Your GP will discuss any other medical conditions you have to determine which antimuscarinics are suitable for you.

Mirabegron

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

Mirabegron causes the bladder muscle to relax, which helps the bladder fill up with and store urine. It is usually taken by mouth once a day.

Side effects of mirabegron can include:

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

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

Medication for nocturia

A medication 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 medication taken late in the afternoon, called a loop diuretic, may also prevent you from 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.

Desmopressin is licensed to treat bedwetting but is not licensed to treat nocturia. Loop diuretics are also not licensed to treat nocturia.

This means that the medication may not have undergone clinical trials (a type of research that tests one treatment against another) to see if it's effective and safe in the treatment of nocturia.

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

If your GP is considering prescribing desmopressin or a loop diuretic, they should tell you that it is unlicensed and will discuss the possible risks and benefits with you.