The International Continence Society (ICS) defines urinary incontinence as every involuntary leakage of urine, i.e., when it is not (always) possible for patients to control the time and place of urination. Furthermore, the ICS differentiates several forms as outlined below.
Urinary incontinence - treatment
The different forms of urinary incontinence require different treatment approaches. The therapeutic options for the individual types are listed below.
Treatment of overactive bladder (urge urinary incontinence)
Treatment of overactive bladder is with drugs (antimuscarinics) in most cases. These calm the bladder musculature and increase bladder capacity.
Treatment of stress incontinence
Conservative measures to strengthen the pelvic floor musculature such as pelvic floor exercises, pelvic training with vaginal cones, electrostimulation or vibration therapy, are the mainstays of treatment for stress incontinence. Drug treatment is possible with oestrogens (especially in women at the menopause) or with medications that stimulate the bladder’s closing mechanism. In severe cases, surgical methods are indicated, such as insertion of a tape or loop to support the structures that hold up the bladder.
Treatment of mixed incontinence
In mixed incontinence, both the urge and stress components must be treated according to the therapeutic options described above.
Treatment of neurogenic detrusor overactivity
The aim of treatment for neurogenic detrusor overactivity is to normalise bladder pressure in order to avoid secondary complications. Antimuscarinics are administered, usually in combination with intermittent catheterisation. As a second-line approach, only in cases where antimuscarinics have not been successful, the uncontrolled contractions of the bladder muscle can also be treated by injection of botulinum A toxin. If these methods are not beneficial, surgical measures are indicated, such as urinary diversion through the abdominal wall, bladder augmentation or neuromodulation.
In overflow incontinence due to increased obstruction of the bladder outlet, surgery (for example, prostatectomy for benign prostatic enlargement) is indicated. If the overflow incontinence is attributable to weak bladder muscle, it is necessary to achieve urination via a catheter. Alternatively, or in addition to this, the bladder muscle can be activated with medications or via electrostimulation.
Treatment of extraurethral incontinence
Extraurethral incontinence is treated by surgical procedures that aim to remove or correct the malformation or injury.