How is urinary incontinence treated?

Updated: Jan 22, 2021
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Treatment is keyed to the type of incontinence. The usual approaches are as follows:

  • Stress incontinence - Surgery, pelvic floor physiotherapy, anti-incontinence devices, and medication
  • Urge incontinence - Changes in diet, behavioral modification, pelvic-floor exercises, and/or medications and new forms of surgical intervention
  • Mixed incontinence - Anticholinergic drugs and surgery
  • Overflow incontinence - Catheterization regimen or diversion
  • Functional incontinence - Treatment of the underlying cause

 Some experts recommend a trial of medical therapy before considering surgical treatment. Others believe that if the incontinence is severe and correctable by surgical means, a trial of medical therapy is not mandatory and need not be performed if the informed patient chooses to proceed directly to surgery.

Treatment of comorbid disease may minimize incontinence episodes. Measures such as smoking cessation, control of asthma, and relief of chronic constipation may be beneficial.

A network meta-analysis of 84 randomized trials of urinary incontinence concluded that behavioral therapies are generally more effective than pharmacologic interventions for stress or urge urinary incontinence, [60] Findings included the following:

  • Except for hormones and periurethral bulking agents, all treatments were more effective than no treatment in achieving at least one favorable outcome

  • For stress incontinence, behavioral therapy outperformed hormones and alpha-agonists, while alpha-agonists and neuromodulation outperformed hormones.

  • For urgency incontinence, behavioral therapy was statistically significantly more effective than anticholinergics in achieving cure or improvement; onabotulinum toxin A may be more effective than neuromodulation in achieving cure, but both interventions were more effective than no treatment. 

  • Second-line interventions (eg, alpha-agonists, anticholinergics) were associated with adverse effects, such as dry mouth.


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