Management
Figure 1. Initial Management of Urinary Incontinence in Women
Screening Questions (Table 5)
Incontinence
on physical
activity
Incontinence
with mixed
symptoms
Incontinence
with
urgency/
frequency
Initial evaluation
>> History and general assessment (Table 2)
>> Physical examination (Table 3)
>> Urinalysis ± urine culture (if infected, treat and reassess)
>> 24-h bladder/voiding diary documenting:
▶ Frequency of urination
▶ Volumes of urination voided
▶ Episodes of incontinence and circumstances
▶ Fluid intake (amount and type)
>> Use of protective pads/garments (type and number/day)
>> Assess post-void residual urine (200 mL high; if
> 500 mL, catheter decompression then reassess)
>> Pad test (optional; 20 min-1h or 24 h)
Stress
incontinence
(sphincter
incompetence
± urethral
hypermobility)
Mixed
incontinence
Treat
predominant
problem first
Complicated incontinence:
>> Recurrent incontinence
>> Continuous leakage
>> Treatment failure
>> Incontinence
associated with:
▶ Pain
▶ Hematuria
▶ Recurrent infection
▶ Elevated PVR
▶ Pelvic irradiation
▶ Radical pelvic surgery
▶ Suspected fistula
>> Pelvic organ prolapse
beyond hymen
>> Neurological disease or
spinal cord injury
Urge
incontinence
(detrusor
overactivity)
Empiric treatments oriented to both urge and stress urinary incontinence
>> Lifestyle modification: smoking cessation, decrease excessive fluid
intake, restrict bladder irritants (caffeine, carbonated beverages, artificial
sweeteners), weight reduction, regular bowel movements, adjust
physical activity
>> Pelvic floor muscle strengthening with (Kegel) exercises ± biofeedback
>> Bladder retraining, urge suppression training, scheduled or prompted
voiding
>> Treat severe atrophic vaginitis with topical estrogen
Stress-specific interventions
>> Devices: provide urethral
support and compression,
tampon, urethral plug, pessary
>> Medications (Table 6)
▶ α-Adrenergic agonist
Failure
Urge-specific interventions
>> Medications (Table 6)
▶ Antimuscarinic
▶ Anticholinergic
Failure
Reassessment or referral for specialist management (Figure 2. Specialist Management)
