Management
Figure 2. Specialist Management of Urinary Incontinence in Women
Incontinence
on physical
activity
Incontinence
with urgency/
frequency
Incontinence
with mixed
symptoms
>> Assess for pelvic organ prolapse
>> Consider cystourethroscopy
>> Consider imaging of urinary tract/pelvic floor (x-ray, fluoroscopy, or ultrasound)
>> Urodynamic evaluation:
▶ Uroflowmetry (evaluates emptying dysfunction)
▶ Cystometry (evaluates sensory and storage function)
▶ Urethral pressure profile and leak point pressures (assesses sphincter function)
▶ Reduction stress testing if prolapse ≥ stage 3
Urodynamic
stress
incontinence
Mixed
incontinence
If initial therapy
for stress
incontinence
failed, consider:
>> Periurethral
bulking agent
injection
>> Sling
>> Retropubic
suspension
>> Artificial urinary
sphincter
>> Alternative: nonsurgical treatments
a
Detrusor
overactivity
incontinence
If initial therapy for
urge incontinence
failed, consider:
>> Neuromodulation
>> Botulinum toxin A
intravesical
injections a
>> Bladder
augmentation
>> Urinary diversion
>> Detrusor
myectomy
>> Alternative: nonsurgical treatments
Incontinence associated
with poor bladder
emptying (PVR)
Bladder outlet
obstruction:
>> Correct
obstruction
(address prolapse,
release urethral
obstructive
surgery)
>> Intermittent
catheterization
Underactive
detrusor:
>> Intermittent
catheterization
>> Suprapubic
catheter
>> Alpha antagonist
>> Neuromodulation
FDA approved for the treatment of urinary incontinence due to detrusor overactivity associated with
a neurologic condition (eg, spinal cord injury [SCI], multiple sclerosis [MS]) in adults who have an
inadequate response to or are intolerant of an anticholinergic medication.
