What are the treatment options?

These are some of the options:

• Behavior modification – Bladder training, timed voiding, pelvic muscle exercises (Kegel’s), biofeedback
• Devices – Vaginal cones and pessaries
• Medicines – Oxybutynin and imipramine usually for urge incontinence only. For both urge and stress incontinence estrogen replacement can be given.

Surgical management:

• Stress urinary incontinence – The medical literature indicates that abdominal surgery has a better long-term cure than vaginal surgery.
• Urge incontinence – When the bladder suddenly contracts and expels urine, this may not be associated with a full bladder or any stress event.
• Laparoscopic surgery – The primary procedure for incontinence is the BURCH procedure. If pelvic prolapse is also associated with urinary incontinence, then site-specific defect repair is performed along with the BURCH procedure.
• Tension Free Vaginal Tape (TVT) – This a recent development in minimally invasive surgery for incontinence. TVT is a 45-minute procedure with long-term cure rates that are similar to those of the laparoscopic BURCH procedure. The recovery is faster than after laparoscopy. TVT is ideal for a patient who has stress urinary incontinence as a sole complaint with minimal prolapse of other tissues.