There are four categories of treatments: behavioral techniques, medications, medical devices, and surgery. Your doctor may want to begin with the behavioral approach, because it is the least invasive. However, treatment should be customized for each patient based on diagnosis, severity of condition, age, and ability to comply with treatment recommendations. Overactive bladder is often treated with medications, and stress incontinence is often treated surgically.

Two primary behavioral therapies are pelvic floor exercises and bladder retraining.

• For pelvic floor exercises, or Kegels, you should imagine that you are trying to stop your urine from flowing. You squeeze those muscles and hold for three seconds. Then you relax for three seconds, and then repeat. It's important not to tighten your abdominal, leg, or buttock muscles. And because it is easy to perform Kegels incorrectly, it's a good idea to have your doctor or a qualified therapist check your technique.

• For bladder retraining, you empty your bladder at set intervals, gradually lengthening the time between trips to the toilet. You are training the bladder to hold more urine, resisting the urge to urinate.

Overactive bladder

Treatment of OAB is focused on reducing bladder spasms and increasing bladder capacity. Typically, doctors recommend a combination of behavioral techniques and medications to achieve greater effect in a short time. These include:

• Reduction of fluid intake

• Reduction of bladder stimulants and irritants, including caffeine and alcohol

• Pelvic floor exercises (Kegels)

• Pelvic floor physical therapy, including biofeedback and electrical stimulation, to improve the muscles and nerves of the pelvis

• Bladder retraining

• Anticholinergic medications such as Detrol, Ditropan, Oxytrol, Vesicare, Enablex, and Sanctura (side effects include dry mouth, constipation, and headache)

Patients who don't respond well to the traditional noninvasive treatments may benefit from neuromodulation techniques, including peripheral acupuncture. Some doctors are experimenting with injecting Botox® into the bladder, but this has not been approved by the Food and Drug Administration.