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. Some patients with preoperative bladder instability have less satisfactory results, but urinary urgency usually resolves after surgery and when necessary, postoperative urgency can be treated with medications. The traditional open abdominal surgical approach has good success rates but requires a longer convalescence. It is especially useful when combined with other procedures such as an abdominal hysterectomy.