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Stress incontinence: alternatives to surgery
1Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
International Journal of Fertility and Women'S Medicine
|June 24, 2005
Summary
Non-surgical treatments for stress incontinence, including pelvic floor muscle training and electrical stimulation, offer alternatives to surgery. While some methods show promise, patient compliance and effectiveness vary, necessitating careful consideration before opting for surgical intervention.
Area of Science:
- Urology
- Gynecology
- Physical Therapy
Background:
- Surgery is a common treatment for stress incontinence.
- Many patients are poor candidates for surgical intervention.
- Non-surgical options warrant exploration before considering surgery.
Purpose of the Study:
- To review non-surgical treatment options for stress incontinence.
- To evaluate the efficacy and limitations of various conservative therapies.
Main Methods:
- Behavioral therapies: pelvic floor muscle training (Kegel exercises) with or without biofeedback.
- Electrical stimulation of the pudendal nerve and pelvic plexus.
- Medical management: hormone replacement therapy, alpha-adrenergic agonists, and serotonin-norepinephrine reuptake inhibitors.
- Mechanical devices: urethral occlusive devices and vaginal pessaries.
Main Results:
- Pelvic floor muscle training is effective but suffers from poor patient compliance.
- Electrical stimulation shows good results for detrusor instability with no long-term compliance issues.
- Medical management has shifted towards serotonin-norepinephrine reuptake inhibitors due to risks and limited efficacy of older treatments.
- Urethral occlusive devices and vaginal pessaries have poor acceptance and performance.
Conclusions:
- Non-surgical approaches for stress incontinence are diverse, ranging from behavioral therapies to medical management and devices.
- Efficacy and patient acceptance vary significantly among these non-surgical options.
- Careful consideration of individual patient factors, compliance, and potential side effects is crucial when selecting conservative treatments for stress incontinence.