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Treatment of urinary incontinence in women

Author
Emily S Lukacz, MD, MAS
Section Editors
Linda Brubaker, MD, FACS, FACOG
Kenneth E Schmader, MD
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Urinary incontinence, the involuntary leakage of urine, is often treated inadequately [1]. In one survey, only 60 percent of patients seeking care for leakage (at least once weekly) recalled receiving any treatment for their incontinence [2]. Additionally, nearly 50 percent of those who did receive treatment reported moderate-to-great frustration with ongoing incontinence.

This topic will discuss the treatment of urinary incontinence in nonpregnant women, focusing on the initial management of stress and urgency incontinence. Overactive bladder (OAB) is a syndrome characterized by urinary urgency, frequency, and nocturia with or without incontinence, and is treated in a similar manner to urgency incontinence.

The evaluation of urinary incontinence in women and urinary incontinence in men are discussed separately. Urinary incontinence in pregnancy is also discussed separately. (See "Urinary incontinence in men" and "Evaluation of women with urinary incontinence" and "Urinary incontinence and pelvic organ prolapse associated with pregnancy and childbirth".)

PRIOR TO INITIATING THERAPY

Identify indications for referral — Indications for further evaluation or referral prior to initiating treatment for urinary incontinence include the presence of associated abdominal/pelvic pain or hematuria in the absence of urinary tract infection, new neurologic symptoms, suspected vesicovaginal fistula or urethral diverticulum, advanced pelvic organ prolapse, uncertainly in diagnosis, history of pelvic reconstructive surgery or pelvic irradiation, or persistently elevated postvoid residual (after treatment of possible causes) (algorithm 1). (See "Evaluation of women with urinary incontinence", section on 'Specialist referral'.)

Assess incontinence type and severity — Determining the classification of urinary incontinence type (stress, urgency, mixed) can help direct treatment (algorithm 1). While most women with incontinence will have improved symptoms with therapy, they may not achieve full continence. Treatment should proceed in a stepwise fashion with emphasis on improving quality of life. Risks and side effects of therapy should be carefully balanced with benefits and aligned with patient goals and expectations. (See "Evaluation of women with urinary incontinence", section on 'Evaluation'.)

                               

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Literature review current through: Nov 2016. | This topic last updated: Wed Oct 12 00:00:00 GMT+00:00 2016.
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