Treatment of urinary incontinence in women
- Emily S Lukacz, MD, MAS
Emily S Lukacz, MD, MAS
- Professor of Reproductive Medicine
- UC San Diego Heath System
- Section Editors
- Linda Brubaker, MD, FACOG
Linda Brubaker, MD, FACOG
- Section Editor — Female Pelvic Medicine and Reconstructive Surgery
- Health Sciences Clinical Professor
- University of California, San Diego
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Urinary incontinence, the involuntary leakage of urine, is often underdiagnosed and undertreated [1-3]. In one survey, only 60 percent of patients seeking care for leakage (at least once weekly) recalled receiving any treatment for their incontinence . 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 stress predominant mixed urinary incontinence.
Overactive bladder (OAB) is a syndrome characterized by urinary urgency, frequency, and nocturia with or without incontinence, and it is treated in a similar manner to urgency incontinence. The treatment of urgency urinary incontinence, OAB and urge predominant mixed urinary incontinence is described separately. (See "Treatment of urgency incontinence/overactive bladder in women".)
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 TREATMENT
Identify indications for referral — Indications for further evaluation or referral for treatment of urinary incontinence include the presence of associated abdominal/pelvic pain, gross or microscopic hematuria in the absence of urinary tract infection, culture-documented recurrent urinary tract infections, new neurologic symptoms, suspected urinary fistula or urethral diverticulum, chronic catheterization, difficulty passing a urinary catheter, pelvic organ prolapse beyond the hymen, history of pelvic reconstructive surgery or pelvic irradiation, or persistently elevated postvoid residual (after treatment of possible causes). (See "Evaluation of women with urinary incontinence", section on 'Specialist referral'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PRIOR TO INITIATING TREATMENT
- Identify indications for referral
- Assess incontinence type and severity
- Pads and protective garments
- INITIAL TREATMENT
- Modifying contributory factors
- Lifestyle modification
- Pelvic floor muscle (Kegel) exercises
- - Initial instructions
- - Supplemental modalities
- Bladder training
- Topical vaginal estrogen
- STRESS INCONTINENCE TREATMENT
- Other specialty treatments
- URGENCY INCONTINENCE/OVERACTIVE BLADDER
- MIXED INCONTINENCE TREATMENT
- OVERFLOW INCONTINENCE
- SPECIAL POPULATIONS
- Pregnant women
- Cognitive impairment
- Neurologic disease
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS