Clinical management of urinary incontinence in women

Real Time Ultrasound

Am Fam Physician. 2013 May 1;87(9):634-40

Hersh L, Salzman B.

Clinical management of urinary incontinence in women.

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.

What Health Point Physiotherapy Does

At Health Point Physiotherapy we have developed our specialised Incontinence and Women's Health program. We routinely use Real Time Ultrasound to assess the strength and control of your core and pelvic floor muscles, teaching you how to engage them correctly and effectively.

During your first session we perform a thorough pelvic floor assessment in order to correctly identify the cause of your incontinence and come up with the best treatment plan.

Pelvic floor exercises are subsequently prescribed and often we recommend Clinical Pilates. When exercises alone are not enough we sometimes use electrotherapy to assist the process.