Female Urinary Incontinence: More Effective Treatment Options than Ever

Thanks to reproductive-related life events — such as pregnancy, childbirth, and menopause — women are twice as likely to develop urinary incontinence as men are. In fact, according to the U.S. Office on Women’s Health, about 4 in 10 women over age 65 unexpectedly leak urine (stress incontinence) or have sudden, strong urges to urinate (urge incontinence) that sometimes end in a bathroom “mistake.”

The bad news is, without treatment, female urinary incontinence tends to worsen. The good news is that effective new treatments give you control over your bladder again, so you don’t have to be embarrassed or line your panties with pads anymore.

At Damon Cobb OB/GYN, a private practice in Poway, California, we determine what type or types of urinary incontinence you have and then custom-design a treatment plan. Some options include:

Risk factor reduction

Being overweight puts extra pressure on your bladder and gradually weakens your pelvic floor muscles. If you’re overweight or obese, our doctors recommend adding in more physical activity and switching to a whole-foods diet that emphasizes fresh vegetables and fruits. If necessary, we refer you to a medical weight-loss clinic.

Cigarette smoking raises your risk for incontinence in two ways. First, the smoke irritates your bladder, which makes it more sensitive and less able to contain large amounts of urine. Second, coughing from smoking puts pressure on your pelvic floor muscles and weakens them so they can’t hold your urine. Dr. Cobb and Dr. Farina Islam urge you to stop smoking and will refer you to a smoking cessation program.

Lifestyle adjustment

If you’re a nonsmoker and at a healthy weight, a few lifestyle adjustments may help alleviate your incontinence. You can try:

Kegel exercises

If your pelvic floor muscles are weak, our doctors recommend squeezing your genital muscles as if to stop the flow of urine, without squeezing your buttocks, abdomen, or legs. Hold for 3 seconds, relax for 3 seconds. Repeat up to 10 times, several times a day.

Bladder training

Keep a diary of how often and when you urinate. Add 15 minutes between your bathroom breaks to help strengthen your bladder so it can hold urine longer.

Diet tweaking

Even if you have a healthy, whole-foods diet, you may have a few habits that increase your risk for incontinence. Our doctors recommend the following:

Cut out caffeine, alcohol, and carbonated beverages, which can irritate your bladder.

Drink at least 90 ounces of water a day to keep hydrated and avoid urinary tract infections.

If you’re constipated, eat high-fiber foods to reduce the pressure of your bowels on your pelvic floor muscles.

Prescription medication

If you’re in menopause, reduced estrogen levels may have weakened your urogenital muscles. Your OB/GYN may recommend topical estrogen to strengthen your pelvic floor muscles and other tissues in your urogenital area.

Other medications, such as mirabegron, help relax your bladder muscle so that it retains more urine. Anticholinergics, such as oxybutynin and tolterodine, can calm an overactive bladder.


This painless procedure entails the insertion of a vaginal probe that emits radio frequency energy to stimulate the production of new collagen. New collagen in turn makes your skin firm and elastic. In so doing, mild urinary incontinence can be remedied mild cases of urinary incontinence.

Botox® injections

You’ve heard about how Botox relaxes dynamic facial muscles to eliminate crow’s feet and other types of wrinkles. But when injected into the bladder muscles, Botox relaxes them, too, so that your bladder can hold more urine without stress or leakage. Botox treatments take about two weeks to work and last for up to 10 months when used to treat urinary incontinence.

Nerve stimulation

Dr. Cobb or Dr. Islam may recommend transcutaneous electrical nerve stimulation (TENS), which strengthens your urogenital muscles with pulses of mild electrical current. The current reaches your nerves through thin wires that they insert into your vagina. The muscle-strengthening effect with TENS is better than that achieved by Kegel exercises.

Pessary device

A pessary is a silicone device shaped like a cube or a diaphragm. Dr. Cobb or Dr. Islam custom-fits and inserts the pessary into your vagina to support your urogenital tissues and muscles, including your:

We instruct you on how to remove, clean, and maintain your pessary. Pessaries relieve incontinence, have a high satisfaction rate, and have few side effects or complications.


If lifestyle adjustments, medications, or a pessary don’t relieve your symptoms or aren’t appropriate in your case, we may advise surgery. Common procedures include slings (tissue or mesh that supports your urethra to keep it closed until you’re ready to urinate) and a suspension procedure (reinforces urethra and bladder neck with stitches). Some types of nerve stimulation can also be done surgically.

To find out how to treat and control your female urinary incontinence, call us today for an evaluation or use our online form to book an appointment.


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