RT Journal Article
SR Electronic
T1 Current trends in the evaluation and management of female urinary incontinence
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 1233
OP 1240
DO 10.1503/cmaj.060034
VO 175
IS 10
A1 Smith, Phillip P.
A1 McCrery, Rebecca J.
A1 Appell, Rodney A.
YR 2006
UL http://www.cmaj.ca/content/175/10/1233.abstract
AB Despite its common occurrence and often seemingly obvious causes, female urinary incontinence requires a thorough and thoughtful evaluation for its proper diagnosis and treatment. With rare exceptions, urinary incontinence is the result of failure of the sphincter mechanism to resist bladder pressures encountered during daily activities. This may be the result of sphincter failure, overactivity of the bladder detrusor muscle or both. In uncomplicated cases, the diagnosis is usually based on an evaluation in the office. Urodynamic and cystoscopic study may be helpful in complex, resistant and recurring cases of urinary incontinence of any cause. Most cases of incontinence may be classified as stress, urge or mixed urinary incontinence. Treatment of stress urinary incontinence focuses on supplementing the urethral continence mechanisms, particularly the urethral supports and periurethral striated muscle function. The current paradigm for the treatment of urge incontinence centres on pharmacologic therapy, primarily by correcting detrusor overactivity with antimuscarinic drugs. Other therapies aimed at altering sensorimotor function may be used in resistant cases. The treatment of mixed urinary incontinence requires consideration of the contribution of each of its components. With proper diagnosis, effective treatment is possible for most patients.