Diagnosis and Treatment of Urinary Incontinence in Women

ABSTRACT

Urinary incontinence (UI) is a prevalent condition that can adversely affect a woman's quality of life. The prevalence of UI among Korean women was estimated up to 42% of the married female population. Overactive bladder syndrome (OAB) is a symptomatic diagnosis based on the presence of urgency, with or without urge incontinence, and usually accompanied by frequency and nocturia, in the absence of obvious pathologic or metabolic disease. Stress urinary incontinence (SUI), the complaint of involuntary loss of urine during effort or exertion or during sneezing or coughing, is the most common type of UI among women. Recommended initial evaluation methods of UI include validated symptom-questionnaire, 24 hour-voiding diary, 1-hour pad test, and provocative stress test. The initial management of OAB requires an integrated approach using behavioral and pharmacologic methods. Patients should be educated about the functioning of the lower urinary tract system, fluid and dietary management, timed or prophylactic voiding and bladder training regimens, and pelvic floor exercises (PFE). Although muscarinic receptor antagonists have been shown to be effective for the treatment of OAB, adverse effects, such as dry mouth, constipation, and blurred vision have limited their usefulness. Most cases of OAB are not cured, but the symptoms are reduced, with an associated improvement in the patients' quality of life. Patients who are not benefited by behavioral and pharmacologic intervention may respond to intravesical administration of drugs, including blockers of afferent input; intradetrusor injection of botulinum toxin, neuromodulation, and augmentation cystoplasty. The initial treatment of SUI includes behavioral changes and PFE. Bladder training, vaginal devices, and urethral inserts may also reduce stress incontinence. Surgical procedures are more likely to cure SUI than nonsurgical procedures. Based on a line of evidences available at this time, colposuspension (such as Burch) and pubovaginal sling (including the newer midurethral synthetic slings such as TVT) are the most effective surgical treatments.