In the most frail patients, it may not be practical to perform a full array of urodynamic studies. Furthermore, urodynamic diagnosis in these patients does not predict responsiveness to bladder training or prompted voiding. If there is no contraindication, behavioral techniques, environmental modifications, or medications should be tried before urodynamic testing is performed. The treatment of urinary stress incontinence includes behavioral, pharmacological, and surgical options. Typically, pelvic floor exercises are conducted for 10-second intervals several times a day.
Medications have an established role in the treatment of stress incontinence.
Women with hypoestrogenism benefit from intravaginal, oral, or transdermal estrogen replacement therapy. A recent meta-analysis demonstrates a favorable effect of estrogen therapy on incontinence in postmenopausal women. These agents presumably increase the internal sphincter tone and bladder outflow resistance. A toileting schedule may also be effective in combination with the behavioral and pharmacological approaches. Patients should be encouraged to urinate at regular intervals and before physical exertion.