Sometimes more sophisticated urodynamic studies are needed to clarify the diagnosis, such as video urodynamics, which combines the cystometrogram with video images of the bladder filling and emptying. This test is especially useful in patients with complex or severe symptoms or those who have had prior bladder surgery. Just as the evaluation of incontinence is tailored to the individual's symptoms, treatment programs are individualized to each patient's needs. Pelvic muscle exercise techniques such as Kegel exercises have been around for years. These exercises are recommended as an initial step for stress incontinence but results are disappointing for those not highly motivated to perform daily exercise routines.
Biofeedback techniques are a useful teaching aid for identifying specific muscle groups to exercise.
Medications may be helpful in the treatment of incontinence. For postmenopausal women, topical estrogens promote a better seal of the urethra, frequently providing dramatic improvement. Anticholinergics inhibit bladder muscle contractions. When combined with timed voiding and fluid restriction, these drugs can improve bladder instability. Surgery for stress incontinence is designed to elevate and support the urethra and bladder neck without causing obstruction of the urethra.