Non-surgical options for incontinence

What guidelines recommend

NICE guidance on pelvic floor dysfunction (NG210) advises a supervised program of at least 3 months for women with stress or mixed urinary incontinence, with at least one review during the program and one at the end.

The International Urogynecological Association (IUGA) says bladder control may not change for 3 to 6 weeks and that full benefit can take up to 6 months. A 2018 Cochrane review found that women with stress incontinence who trained were far more likely to report that their leaking had stopped than women who had no treatment. Most trials followed women for less than 12 months.

Radiofrequency and fractional laser

Podo offers radiofrequency and fractional laser treatments of the vagina as non-surgical options for incontinence. The choice between them is made after measurement.

In general, treatments of this kind aim to improve the tone of the vaginal wall and the tissue around the urethra. They are used for mild laxity and mild leaking, and they do not repair ligaments that have failed. They are usually given as a series of sessions.

What to know about the evidence

In July 2018 the US Food and Drug Administration (FDA) issued a safety communication on energy-based devices used for vaginal procedures. It said that the safety and effectiveness of these devices for treating conditions such as urinary incontinence had not been established. It said they may be associated with serious adverse events, including vaginal burns, scarring, pain during sex and recurring or chronic pain.

If any clinic offers you one of these treatments, ask what evidence supports it for your condition and what risks have been reported.

Medication and bladder training

For urgency and mixed incontinence, bladder training and medication treat the urge component. Stress leaking does not respond to medication.

Vaginal estrogen is prescribed when appropriate. Dryness and thinning of the vaginal tissue after menopause can add to urinary symptoms, and a doctor can advise whether estrogen suits you.

Bulking injections

Urethral bulking injections are offered at the clinic; Burch colposuspension is not performed. NICE notes that repeat injections may be needed, that limited evidence suggests bulking agents are less effective than the surgical procedures it lists, and that the effects wear off over time.

When surgery is the more appropriate option

When leaking limits your life despite training, when measurement shows the supports have failed, or when prolapse is also present. Pelvic ligament suspension is the mesh-free option at Podo, and we explain it on its own page. The clinic performs both operations for stress urinary incontinence: pelvic ligament suspension, which uses the patient's own ligaments without synthetic mesh, and the mid-urethral synthetic mesh sling. Which one suits you is decided after examination and measurement.

The technique restores pelvic support by re-anchoring the patient's own lax pelvic ligaments. Pelvic ligament suspension for incontinence alone is performed under IV sedation, with same-day discharge. Plan for 5 to 10 days in Seoul after incontinence or prolapse surgery.

For visitors

Treatments given as a series of sessions are easier to complete if you live in or near Seoul. If you are traveling for treatment, we tell you whether a non-surgical plan is realistic in your time frame.

Insurance is a separate question. Whether a procedure is reimbursed depends on your policy; we provide documentation, not coverage decisions.

Sources

1. NICE guideline NG210: Pelvic floor dysfunction: prevention and non-surgical management
2. NICE NG123: Urinary incontinence and pelvic organ prolapse in women: management
3. Cochrane review (2018): Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women
4. IUGA repost of the US FDA Safety Communication of July 30, 2018: energy-based devices marketed for vaginal rejuvenation or cosmetic vaginal procedures