Urinary incontinence: primary care therapies for the older woman

Work-up of the older woman with urinary incontinence includes a complete physical, pelvic and rectal examinations, and a neurologic exam. The primary care physician can usually leave post-void residual testing to the specialist. Lab tests include urinalysis and urine culture, as well as basic blood tests. If the patient is referred, the specialist may do other testing, such as urodynamics or cystometry. The choice of therapy depends on the cause and severity of each patient's symptoms. Primary care treatment options for mild to moderate incontinence include pelvic muscle exercises, bladder retraining, and biofeedback--all of which can be taught by a physical therapist. Other noninvasive treatments include estrogen replacement therapy and anticholinergic and other drug therapies.