Urinary Incontinence in the Young Woman

Urinary Incontinence in the Young Woman; Treatment Plans and Options Available: Executive Summary

Dudley Robinson, MD, FRCOG; Linda Cardozo, MD, FRCOG


Executive Summary
Epidemiology

Urinary incontinence is a common and distressing condition that has a significant impact on quality of life.
The incidence of urinary incontinence increases with age.

Clinical Symptoms & Signs

Stress incontinence may be a symptom (stress urinary incontinence), a sign demonstrable on examination or a diagnosis following urodynamics (urodynamic stress incontinence).
An overactive bladder is a symptomatic diagnosis, while detrusor overactivity is a urodynamic diagnosis. The terms, although often used interchangeably, are not synonymous.

Investigations

Basic investigations in primary care include urinalysis to exclude infection and a postvoid residual.
Women with refractory or unusual symptoms should be referred to secondary care for further investigation, including urodynamic investigations.

Management

All women benefit from lifestyle advice and bladder retraining.
Women with stress urinary incontinence should be offered pelvic floor muscle training in the first instance, although many will benefit from continence surgery.
Midurethral tapes (retropubic and transobturator) are the most commonly used procedures and have comparable efficacy.
Drug therapy remains integral in the management of an overactive bladder and, currently, antimuscarinic agents are the most commonly prescribed agents.
Botulinum toxin and neuromodulation may be useful in patients with refractory overactive bladder symptoms and a urodynamic diagnosis of detrusor overactivity.

Reprint Address

Dudley Robinson, MD, FRCOG, Department of Urogynaecology, Kings College Hospital, London, UK; Tel.:+44 203 299 3568, Fax:+44 299 3449. dudley.robinson@nhs.net.

Women's Health. 2014;10(2):201-217. © 2014 Future Medicine Ltd.