The main treatments depend on what type of incontinence you have

Bladder incontinence is treated differently depending on whether you leak with coughing and exercise (stress incontinence), have sudden urges you cannot control (urge incontinence), or experience other patterns. Your doctor will ask about when leaks happen, how often, and what triggers them — that information points to which treatments are most likely to work for you.

Most people start with behavioral changes and exercises before trying medication or procedures. These approaches have no side effects, cost nothing, and often reduce leaks enough that you do not need further treatment. If those do not work fully, medication, devices, or procedures become the next step.

Key Takeaways

  • Pelvic floor exercises (Kegel exercises) reduce stress incontinence in about half of people who do them consistently for at least six weeks.
  • Bladder retraining — gradually extending the time between bathroom visits — helps urge incontinence by teaching your bladder to hold more.
  • Medications like oxybutynin and mirabegron reduce urge incontinence but work best combined with behavioral changes, not alone.
  • Pessaries, absorbent pads, and catheterization are management tools that do not cure incontinence but let you stay active while you pursue other treatment.
  • A urogynecologist or urologist can test which type of incontinence you have and recommend the treatment most likely to work for your situation.

Pelvic floor exercises and how to do them correctly

Pelvic floor exercises (Kegel exercises) strengthen the muscles that support your bladder and urethra. These muscles naturally weaken with age, childbirth, and prostate surgery — strengthening them reduces leaks during coughing, sneezing, exercise, and lifting. The exercises work best for stress incontinence and take six to twelve weeks of consistent practice before you notice improvement.

To find the right muscles, stop the flow of urine midstream the next time you urinate — the muscles you use are your pelvic floor. Once you know which muscles to use, you can do the exercises anywhere, anytime. Squeeze those muscles for three seconds, then relax for three seconds. Repeat ten times. Do this routine three times a day. As the muscles get stronger, gradually increase the squeeze to five or ten seconds, and increase the number of repetitions to fifteen or twenty.

A physical therapist who specializes in pelvic floor therapy can watch you perform the exercises and correct your form — many people tighten the wrong muscles or hold their breath, which reduces effectiveness. Ask your doctor for a referral, or search for "pelvic floor physical therapy" in your area. Some insurance plans cover these sessions if your doctor writes an order.

Bladder retraining for urge incontinence

Bladder retraining teaches your bladder to hold more urine and reduces the sudden urges that lead to leaks. It works by gradually extending the time between bathroom visits on a fixed schedule, rather than going whenever you feel the urge. This approach works best for urge incontinence and mixed incontinence (both stress and urge).

Start by tracking when you urinate for three days — write down the time of each bathroom visit. Then set a bathroom schedule based on your current pattern. For example, if you go every hour, schedule bathroom visits every hour and fifteen minutes. Use the bathroom only at those scheduled times, even if you feel an urge before then. When an urge comes between visits, use relaxation techniques: take slow, deep breaths, sit down if possible, and wait five minutes before going to the bathroom. After one week at the new interval, increase it by another fifteen minutes. Continue increasing the interval by fifteen minutes each week until you reach three to four hours between visits.

Bladder retraining takes four to six weeks to show results and works best when combined with pelvic floor exercises or medication. Keep a diary during the process so you and your doctor can track progress and adjust the schedule if needed.

Medications that reduce urge and stress incontinence

Several medications reduce incontinence by different mechanisms. Anticholinergic medications like oxybutynin, tolterodine, and solifenacin calm an overactive bladder by blocking nerve signals that trigger sudden urges. These work best for urge incontinence. Mirabegron works differently — it relaxes the bladder muscle — and causes fewer side effects than anticholinergics in some people. Duloxetine is an antidepressant that strengthens the muscles around the urethra and is used for stress incontinence.

Anticholinergic medications can cause dry mouth, constipation, blurred vision, and confusion, especially in older adults. Mirabegron may raise blood pressure. Duloxetine can cause nausea and dizziness. Your doctor will start with a low dose and increase it gradually to find the dose that reduces leaks while keeping side effects tolerable. Medications work best when combined with behavioral changes — pelvic floor exercises or bladder retraining — rather than used alone.

Tell your doctor about all other medications you take, because some interact with incontinence drugs. If one medication causes side effects you cannot tolerate, other options exist; do not stop taking it without talking to your doctor first.

Devices and pessaries that support the urethra

A pessary is a small silicone or plastic device inserted into the vagina that supports the urethra and bladder neck, reducing stress incontinence during activity. Pessaries work when ready and are removed at night or whenever you want. They are most useful for women with moderate stress incontinence who want to stay active without surgery.

A urogynecologist or nurse practitioner fits a pessary to your anatomy — it must be the right size and shape or it will not work and may cause discomfort. After fitting, you learn to insert and remove it yourself. Some women wear it all day; others use it only during exercise or activities that trigger leaks. Pessaries require regular cleaning and occasional replacement.

Other devices include urethral inserts (small plugs inserted into the urethra before activity) and external collection devices (like condom catheters for men). These are less common but useful for people who do not want surgery or medication. Your doctor can discuss which device fits your situation.

Procedures and surgery when other treatments do not work

If behavioral changes, exercises, and medication do not reduce leaks enough, several procedures can help. Botulinum toxin (Botox) injections into the bladder muscle relax an overactive bladder and reduce urge incontinence. The effect lasts three to six months, so injections must be repeated. Sacral neuromodulation uses a small implanted device that sends electrical signals to nerves controlling the bladder, reducing urge incontinence in about 60 percent of people who try it.

Surgical slings are the most common surgery for stress incontinence. A surgeon places a thin strip of mesh or tissue under the urethra to support it and prevent leaks during coughing, sneezing, and exercise. Success rates are 80 to 90 percent, though some women experience urinary retention or new urge incontinence after surgery. Bulking injections add material around the urethra to increase pressure and reduce stress leaks; these are less invasive than slings but may need to be repeated.

Surgery is considered only after other treatments have been tried and found insufficient. Discuss the risks, benefits, and recovery time with a urogynecologist or urologist before deciding.

Absorbent products and catheterization for daily management

While you pursue treatment, absorbent pads, protective underwear, and other products let you stay active and social without fear of leaks. Pads range from thin liners for light leaking to heavy-absorbency products for moderate to severe incontinence. Many people use different products for different situations — a thin pad during the day at work, a heavier pad at night, and a protective undergarment during exercise.

Products are sold at drugstores, supermarkets, and online retailers. Costs vary widely; buying in bulk or using store brands reduces expense. Some insurance plans and Medicaid programs cover incontinence products if your doctor writes an order, so ask before paying out of pocket.

Catheterization — inserting a tube into the bladder to drain urine — is used when incontinence is severe or when other treatments have failed. Intermittent catheterization (inserting a catheter several times a day and removing it) is cleaner and safer than leaving a catheter in place continuously. A nurse or doctor teaches you how to insert a catheter safely and how to prevent infection. This approach works for people with severe incontinence or those who cannot empty their bladder completely.

When to see a doctor and what tests to expect

See your primary care doctor if incontinence interferes with daily life, happens more than once a week, or started suddenly. Your doctor will ask detailed questions about when leaks happen, how much you leak, and what triggers them. They will perform a physical exam and may order a urinalysis to rule out infection.

If your primary care doctor cannot determine the cause or if initial treatment does not work, you will be referred to a urologist (for all genders) or urogynecologist (for women). These specialists may order a post-void residual test (ultrasound to measure how much urine stays in your bladder after you urinate), urodynamic testing (which measures bladder pressure and flow), or cystoscopy (a camera inserted into the bladder to look for abnormalities). These tests identify the type of incontinence and guide treatment decisions.

Testing takes one to two hours and is usually done in an outpatient clinic. Results come back within a few days to a week, and your doctor will discuss treatment options based on what the tests show.

Frequently Asked Questions

How long does it take for pelvic floor exercises to work?

Most people notice improvement in four to six weeks of consistent practice, though full benefit may take twelve weeks. Results depend on how often you do the exercises — daily practice works faster than a few times a week. If you see no improvement after twelve weeks, ask your doctor whether you are doing the exercises correctly or whether a different treatment might work better.

Can incontinence go away on its own?

Incontinence caused by a urinary tract infection often goes away once the infection is treated. Incontinence from age, childbirth, or prostate surgery does not go away without treatment, but it often improves with exercises and behavioral changes. Some people find that leaks decrease naturally over months or years, but this is not reliable enough to count on.

Is surgery the only way to cure stress incontinence?

Surgery is not the only option. Pelvic floor exercises reduce stress incontinence in about half of people who do them consistently. Pessaries, absorbent products, and behavioral changes help many others manage leaks without surgery. Surgery is most effective but is considered only after other treatments have been tried.

What should I do if medication causes side effects?

Tell your doctor about side effects — do not stop taking the medication on your own. Your doctor can lower the dose, switch you to a different medication, or recommend a different treatment approach. Many people find a medication that works with tolerable side effects after trying two or three options.

Can I use incontinence products while pursuing treatment?

Yes. Products are a practical tool while you work on exercises, behavioral changes, or medication. Using them does not slow down or interfere with other treatments. Many people continue using products even after treatment reduces leaks, because they provide confidence and security during activities like travel or exercise.