The main treatments depend on what type of incontinence you have

Urinary incontinence is treated differently depending on whether you leak with coughing and exercise (stress incontinence), have sudden urges you cannot control (urgency 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 pelvic floor exercises before trying medication or procedures. These approaches work for many people and have no side effects. If those do not reduce leaks enough, medication, devices, or in some cases surgery become options worth discussing with your doctor.

Key Takeaways

  • Pelvic floor muscle exercises (Kegel exercises) reduce leaks in stress incontinence and can improve urgency incontinence, and they work best when done correctly and consistently for several weeks.
  • Behavioral changes like limiting fluids before bed, timing bathroom visits, and avoiding bladder irritants often reduce leaks without medication.
  • Medications for urgency incontinence work by relaxing the bladder muscle, but they can cause dry mouth and constipation, and they do not work for stress incontinence.
  • Devices like pessaries or urethral inserts, and procedures like nerve stimulation or injections, are options when exercises and medication do not reduce leaks enough.
  • Your primary care doctor or a urologist can help you figure out which approach fits your type of incontinence and your daily life.

Pelvic floor exercises and how to do them correctly

Pelvic floor muscles support your bladder and urethra. When they weaken, stress incontinence—leaking during coughing, sneezing, or exercise—becomes more likely. Strengthening these muscles through repeated contractions can reduce or stop those leaks. The exercises are called Kegel exercises or pelvic floor muscle training.

To find the right muscles, stop the flow of urine midstream the next time you urinate. The muscles you use are your pelvic floor muscles. Once you know which ones they are, you can exercise them anywhere, anytime—sitting at a desk, standing in line, or lying in bed. Squeeze those muscles for three seconds, then relax for three seconds. Start with 10 repetitions, three times a day. Over weeks, work up to holding the squeeze for 10 seconds and doing 25 to 30 repetitions per session.

Results usually take four to six weeks of consistent practice. Many people see improvement in stress incontinence within that time. For urgency incontinence, pelvic floor exercises can help but often work better combined with other approaches. A physical therapist who specializes in pelvic health can watch you perform the exercises and correct your technique, which makes them more effective.

Behavioral changes that reduce leaks

Before medication or procedures, doctors recommend changes to daily habits that often reduce incontinence on their own. These include limiting fluids in the evening so you urinate less at night, avoiding caffeine and alcohol (which irritate the bladder), and using the bathroom on a schedule rather than waiting for the urge to hit.

Scheduled voiding means going to the bathroom at set times—for example, every two hours during the day—whether you feel the urge or not. This prevents the bladder from becoming too full and triggering leaks. Over time, you can gradually extend the time between bathroom visits. This approach works well for urgency incontinence and for people who leak frequently throughout the day.

Weight loss, if you are overweight, also reduces pressure on the bladder and can decrease leaks. Even a 5 to 10 percent reduction in body weight can make a noticeable difference. Avoiding constipation matters too—a full bowel presses on the bladder and can worsen incontinence. Drinking enough water (unless your doctor says otherwise), eating fiber, and staying active help prevent constipation.

Medications for urgency incontinence

Medications called anticholinergics relax the bladder muscle, reducing sudden urges and leaks. Common ones include oxybutynin, tolterodine, and solifenacin. These work only for urgency incontinence (sudden urges), not stress incontinence (leaking with activity). Your doctor will start with a low dose and adjust it based on how well it works and what side effects you experience.

The most common side effect is dry mouth. Others include constipation, blurred vision, and dizziness. Some people cannot tolerate these side effects or find the medication does not reduce leaks enough. If that happens, your doctor can try a different medication or a different class of drug—for example, mirabapron, which works through a different mechanism and may cause fewer side effects for some people.

Medications work best when combined with behavioral changes like scheduled voiding and limiting fluids. They do not cure incontinence; they manage it while you are taking them. If you stop the medication, leaks usually return.

Devices and procedures when other treatments do not work enough

If exercises, behavioral changes, and medication do not reduce leaks to a level you can live with, several devices and procedures are available. A pessary is a small silicone device inserted into the vagina that supports the urethra and reduces stress incontinence. A doctor or nurse fits it to your anatomy, and you can remove and reinsert it yourself or leave it in place. Some women use it only during exercise or activities that trigger leaks.

A urethral insert is a small disposable device that sits in the urethra and blocks urine flow. You insert it before activity and remove it to urinate. These work for stress incontinence during specific activities.

Nerve stimulation (sacral neuromodulation) involves a small device implanted under the skin that sends electrical pulses to nerves controlling the bladder. It reduces urgency incontinence and frequency in people who have not responded to medication. The procedure requires surgery, but it is reversible.

Botulinum toxin injections into the bladder muscle relax it and reduce urgency incontinence. Results last three to six months, so you need repeat injections. This is typically reserved for people who cannot tolerate medication or for whom medication has not worked.

Surgical procedures to lift and support the urethra can reduce stress incontinence, especially in women. These are considered when other treatments have not worked and incontinence significantly affects quality of life. Surgery carries risks like any procedure, so your doctor will discuss whether the benefit outweighs those risks in your situation.

Working with your doctor to choose a treatment

Start by seeing your primary care doctor or asking for a referral to a urologist or urogynecologist (a gynecologist who specializes in urinary problems). Before your appointment, write down when leaks happen, what triggers them, how many times a day you urinate, and how much the incontinence affects your daily activities. Bring a list of all medications and supplements you take.

Your doctor may ask you to keep a bladder diary for a few days—recording when you urinate, how much you drink, and when leaks occur. This information helps identify patterns and guides treatment choices. Some doctors order a urinalysis to rule out infection, which can cause temporary incontinence.

Treatment is not one-size-fits-all. Your doctor will recommend an approach based on your type of incontinence, how severe it is, your overall health, and what matters most to you. Many people benefit from starting with pelvic floor exercises and behavioral changes, then adding medication if needed. Others may skip directly to other options depending on their situation. The goal is to find what reduces leaks and fits into your life.

Frequently Asked Questions

How long do pelvic floor exercises take to work?

Most people notice improvement within four to six weeks of consistent practice, though some see results sooner. You need to do the exercises regularly—at least three times a day—for them to be effective. If you do not see improvement after eight weeks, ask your doctor or a pelvic floor physical therapist to check your technique, as incorrect form is common.

Can incontinence go away on its own?

Some types can improve with time, especially after childbirth or surgery. Others, like age-related urgency incontinence, tend to persist or worsen without treatment. Starting treatment early—even with simple behavioral changes—often prevents incontinence from becoming more severe.

What if medication causes side effects I cannot tolerate?

Tell your doctor immediately. They can lower the dose, switch you to a different medication, or try a different class of drug altogether. Some people do better with one medication than another. Do not stop taking it on your own without talking to your doctor first.

Is surgery the only option if nothing else works?

No. Devices like pessaries and urethral inserts, nerve stimulation, and injections are all options before or instead of surgery. Your doctor can discuss which ones make sense for your type of incontinence and what you have already tried.

Will my insurance cover treatment?

Coverage varies by insurance plan and the specific treatment. Pelvic floor physical therapy, medications, and some procedures are often covered, but you may need a referral or prior authorization. Call your insurance company or ask your doctor's office to check your coverage before starting treatment.