title: Clinical management of urinary incontinence in women.
abstract: Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed. A stepped-care approach that advances from least invasive (behavioral modification) to more invasive (surgery) interventions is recommended. Bladder retraining and pelvic floor muscle exercises are first-line treatments for persons without cognitive impairment who present with urge incontinence. Neuromodulation devices, such as posterior tibial nerve stimulators, are an option for urge incontinence that does not respond to behavioral therapy. Pharmacologic therapy with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful; however, because of adverse effects, these agents are not recommended in older adults. Other medication options for urge incontinence include mirabegron and onabotulinumtoxinA. Sacral nerve stimulators, which are surgically implanted, have also been shown to improve symptoms of urge incontinence. Pelvic floor muscle exercises are considered first-line treatment for stress incontinence. Noninvasive electrical and magnetic stimulation devices are also available. Alternatives for treating stress incontinence include vaginal inserts, such as pessaries, and urethral plugs. Limited or conflicting evidence exists for the use of medications for stress incontinence; no medications are approved by the U.S. Food and Drug Administration for this condition. Minimally invasive procedures, including radiofrequency denaturation of the urethra and injection of periurethral bulking agents, can be used if stress incontinence does not respond to less invasive treatments. Surgical interventions, such as sling and urethropexy procedures, should be reserved for stress incontinence that has not responded to other treatments.
authors.affiliation: Department of Family and Community Medicine, Division of Geriatric Medicine and Palliative Care, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hersh
authors.forename: Brooke
authors.initials: B
authors.lastname: Salzman
mesh_terms: D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D019736:Prostheses and Implants; D014549:Urinary Incontinence / Q000145:classification / Q000175:diagnosis / Q000628:therapy*
chemical_list: D018680:Cholinergic Antagonists