Stress incontinence is characterized by daytime leakage of urine on movement or Valsalva maneuver. Patients with detrusor instability are often older and report an overwhelming urge to void, large urinary loss and nocturia. The integrity of the pelvic floor muscles may be better assessed when the patient is examined in a standing position. Once the diagnosis has been established, therapies such as treatment of constipation, weight loss and adjustment of fluid intake may have dramatic results. Estrogen therapy may also be helpful.
Pelvic floor exercises benefit both types of incontinence.
Patients with detrusor instability should attempt bladder training by voiding regularly and frequently to retrain the bladder over a period of several weeks. Anticholinergic drugs such as oxybutinin may be helpful, but their use is limited by side effects. Imipramine is a useful therapy in patients with nocturia. Electric and mechanical devices are also available for the treatment of urinary incontinence in selected patients. When a case of meningococcal meningitis occurs in a community, family physicians should be prepared to give appropriate prophylactic advice.