Urinary incontinence is a common problem, especially in older people, but that does not mean one has to resign themselves to living with it, nor that surgery is the only solution. Nowadays, there are multiple non-surgical treatments for urinary incontinence that are effective, safe, and adaptable to every situation.
In this article, we explain what non-invasive options exist, when they are recommended, and how to combine them to improve urinary control, autonomy, and quality of life.
Can urinary incontinence be treated without surgery?
In most cases, urinary incontinence can be treated without surgery, especially when it is diagnosed early and an integrated approach is adopted. In fact, clinical guidelines always recommend starting with conservative treatment, reserving surgery only for very specific cases or when previous options have not worked.
The appropriate treatment will depend on:
- The type of incontinence (stress, urge, mixed, functional...). If you want to know more about the types of incontinence, consult our article Urinary incontinence in older people.
- Age and general state of health
- The person's degree of autonomy
- The impact on quality of life
Lifestyle changes to treat urinary incontinence without surgery
Lifestyle changes and behavioral treatment are the first line of defense for treating urinary incontinence without surgery. Although they may seem simple, they have a very significant impact.
Bladder training and scheduled voiding for urinary incontinence
It is a technique that seeks to retrain the bladder, helping to increase control and decrease frequency and urgency by establishing regular bathroom schedules. Training requires daily consistency for 6 to 8 weeks and is indicated for cases of urge incontinence and overactive bladder.
- Start by keeping a diary of when you urinate and when you have leaks
- Then, set fixed times to urinate (every 2-3 hours)
- Practice gradually holding urine, increasing intervals by 15 minutes each week
Fluid intake modification for urinary incontinence
- Maintain adequate hydration (1.5 to 2L per day; it is not about drinking less) but avoid drinking large amounts all at once
- Spread hydration throughout the day
- Reduce fluids 2 hours before bed if there are nighttime leaks
Avoiding bladder irritants
Some foods and drinks irritate the bladder lining and worsen some symptoms.
Avoid or reduce substances such as coffee or energy drinks, alcohol, soft drinks, citrus fruits like oranges or tomatoes, spicy foods, or chocolate, as they can increase urinary urgency and leaks.
Constipation control
Constipation puts pressure on the bladder and worsens incontinence. Controlling it is key, especially in older people. For this, it is recommended to:
- Increase fiber (fruits, vegetables, whole grains...)
- Drink enough water
- Exercise
- Avoid chronic laxative use without medical supervision
Double or controlled voiding
This consists of urinating, waiting a few minutes while sitting, and trying again to empty the bladder completely. It is useful in cases of overflow or incomplete emptying.
Pelvic floor exercises for urinary incontinence
Pelvic floor exercises, also known as Kegel exercises, are one of the most effective tools for treating urinary incontinence without surgery. These exercises:
- Strengthen the muscles that support the bladder and the sphincter
- Improve urine control
- Are especially effective in stress and mixed incontinence
To obtain results, consistency is fundamental. In older people, the best results are achieved when exercises are guided by a professional, such as a physical therapist specializing in the pelvic floor.
Electrical stimulation for urinary incontinence: EMS, TENS, and PTNS
Electrical stimulation for urinary incontinence is a non-invasive option increasingly used, especially when it is difficult to perform the exercises voluntarily or when the incontinence is moderate.
Although the use of these is very common in clinical settings, at home, electrical stimulation devices like the TENS EMS NMS60 allow for the simple and safe application of specific EMS and TENS programs. This type of device can be effective support for people who need to reinforce conservative treatment, improve adherence, and maintain a regular pelvic floor stimulation routine.
Pharmacological treatment for urinary incontinence
When conservative measures are not enough, pharmacological treatment for urinary incontinence may be considered, always under medical supervision.
Among the most commonly used drugs are:
- Antimuscarinics, which reduce involuntary bladder contractions.
- Beta-3 agonists (mirabegron), which relax the bladder muscle.
- Topical estrogens, in postmenopausal women with urogenital atrophy
- Alpha-blockers, in men with prostatic hyperplasia.
In older people, it is essential to assess potential side effects and interactions with other medications.
Other minimally invasive treatments for urinary incontinence
Before considering surgery, there are minimally invasive treatments that can be effective in different cases:
- Botulinum toxin injections into the bladder, for refractory overactive bladder.
- Urethral bulking agent injections, for mild stress incontinence.
- Sacral stimulation, via a neurostimulator implant, in more advanced cases.
Non-surgical treatment for urinary incontinence: a progressive and personalized approach
Non-surgical treatment for urinary incontinence must always be approached in a progressive and personalized way, adapting to the type of incontinence, the state of health, and each person's degree of autonomy. In most cases, conservative measures (such as lifestyle changes, bladder training, and pelvic floor exercises) significantly improve urinary control and quality of life. When these strategies are not enough, there are complementary non-invasive options, such as electrical stimulation or pharmacological treatment, which can be combined under professional supervision before considering more advanced alternatives.
