There are two main types of urinary leakage in women: stress incontinence (leaking with straining, such as coughing, sneezing, and laughing) and urge incontinence (leaking immediately after a strong urge, sometimes called overactive bladder, particularly when associated with urinary frequency).

Urge Incontinence

This is thought to result from the bladder becoming unstable or spasmodic.

Management of urge incontinence include:

• Working with a physical therapist (bladder retraining)
• Pharmacologic therapy with ‘antispasmodic’ medications (such as oxybutynin, Ditropan, Levsin, tolterodine, Detrol, Enablex, Vesicare, Toviaz, Sanctura, Gelnique and Oxytrol). These drugs can have side effects, including dry mouth and constipation.
• A limited course of estrogen vaginal cream can help with some of the symptoms, in certain post-menopausal women.
• For the unusual patient who does not respond to standard treatment, sacral neuromodulation, percutaneous tibial nerve stimulation, and/or botox injections into the bladder are considered.

There are no surgical options specifically for the treatment of urge incontinence.

Stress Incontinence

This occurs when the muscles and tissues around the urethra (where urine exits) do not close properly when there is increased pressure ("stress") in the abdomen, which then leads to urine leakage. Stress incontinence is a common reason for incontinence in women, especially those who have had children and/or are overweight.

Management of stress incontinence include:

• Kegel exercises (on your own)
• Working with a physical therapist (pelvic muscle strengthening)
• Surgical procedures

There are no FDA-approved medications for this.

Surgical treatment for stress incontinence has seen revolutionary changes over the last 10 years, particularly with new minimally invasive techniques that have been proven safe and effective. The TVT mid-urethral sling was first developed in the late 1990s and is still the most common procedure performed for stress incontinence. The similar TOT mid-urethral sling followed and also has good results. Newer ‘mini-slings’ are now being used by some surgeons, though the long-term effectiveness of these is still not entirely clear.

At The Everett Clinic, our urologists are well-trained and experienced in the evaluation and treatment of female urinary incontinence; including the minimally invasive surgical management of stress incontinence (some of us favor the TVT sling, while others prefer the TOT sling).