Treatment of Urinary Incontinence

Initial Management

The American College of Physicians recommends pelvic floor muscle training as the first-line treatment for stress urinary incontinence, with weight loss as an important adjunct in obese women 1, 2
Pelvic floor muscle training demonstrates superior cure rates, symptom improvement, satisfaction, and quality of life compared to no treatment in patients with stress urinary incontinence 1
Weight loss significantly improves stress incontinence symptoms in obese women, with greater benefit for stress versus urge incontinence 1

Synthetic midurethral mesh slings are the primary surgical treatment for stress urinary incontinence, with 48-90% symptom improvement and less than 5% mesh complications 1, 3
The American Urological Association recommends confirming stress incontinence objectively with cough stress test before proceeding to surgery 4, 2

The International Continence Society recommends treating the most bothersome symptom component first, typically combining pelvic floor muscle training with bladder training for mixed incontinence 2
Combining pelvic floor muscle training with bladder training is recommended as initial therapy for mixed incontinence, with prioritization of the most bothersome symptom component 2, 1
Antimuscarinic drugs are recommended for urge or mixed incontinence when behavioral interventions are insufficient, with modest absolute benefit (<20% absolute risk difference) 5, 1

The American College of Physicians recommends reassessing treatment response after 2-4 weeks of behavioral interventions 2
Voiding diaries are recommended to objectively document improvement in frequency and incontinence episodes 2
Close monitoring is recommended for medication side effects, particularly cognitive changes and constipation with antimuscarinics 2

Post-void residual measurement is mandatory to rule out overflow incontinence before initiating treatment for other incontinence types 2
The American Urological Association recommends never proceeding to surgical treatment without first confirming the incontinence type through history, physical exam, and post-void residual measurement 4, 2