Non-Surgical Treatment of Urinary Incontinence

Medications

Certain medications have been known to decrease symptoms of an overactive bladder. These medications have to be prescribed by your doctor and work by enhancing the ability of the bladder to store urine. Examples of this type of medication are: Detrol LA, Ditropan XL, Vesicare, Enablex and Santura. Medications such as Hytrin, Flomax, Cardura, and Uroxatral relax the muscle of the bladder neck and prostate reducing resistance to flow of urine and the work that the bladder muscle needs to do for urination to occur. With time, and because the force needed to urinate is reduced, the detrusor bladder muscle becomes thinner and more elastic, thus increasing the bladder capacity to store urine. 

Procedures

Any procedure that reduces urinary obstruction, generally caused by prostate enlargement, may also alleviate symptoms of OAB. These are described in the BPH section of this web site: Microwave (thermo) therapy, Green Light Laser and trans urethral resection of the prostate. 

Treatment options

• Absorbent products: Absorbent pads, diapers and garments can deal with incontinence.

• Medication: No FDA approved medication for stress incontinence in men. Antidepressants/Antihistamine effect on bladder

• Devices

• Behavioral modification

• Biofeedback

• Injectables

• Surgery 

• Male sling 

Devices

Clamps: Cunningham clamp, C3-clamp

Advantages: 

• Non-medical, non-surgical

• Easy to use

• Works well

Disadvantages: 

• Bulky

• Pressure necrosis

• Generally not a turn on
  
  

Catheters  

Advantages: 

• Works

Disadvantages:

• Attached to a bag

• Increased risk of infection

 Behavioral modification

• Decrease fluid intake

• Void frequently

• Avoid caffeine, alcohol

• Avoid activity that increases intraabdominal pressure 

 Pelvic floor rehabilitation

• a.k.a. biofeedback

• Means of teaching Kegel exercises

• Objective way to measuring pelvic floor strength

   

Bulking agents

• Collagen (Success rates for collagen ~ 17% after prostatectomy)

• Carbon beads

• Autologous fat

Advantages:

• Relatively safe

• Office or outpatient

• Long term data available

Disadvantages: 

• Skin test: delayed hypersensitivity

• Expensive 

• Low cure rate

• Repeat treatments

Surgical Treatment Options