Non-Surgical Management of Urinary Incontinence

Urinary incontinence management varies depending on the type of incontinence and severity of symptoms. Types of incontinence include stress (SUI), urge or overactive bladder (OAB), mixed, neurogenic, and overflow incontinence. First-line treatment for OAB and SUI is nonpharmacologic management. Behavioral therapy is first-line treatment for urge incontinence. Vaginal mechanical devices (cones, pessaries, and urethral plugs), pelvic floor muscle training, and electroacupuncture are recommended as first-line treatment for women with SUI. Biofeedback and electric muscle stimulation can be adjunctive therapy for SUI. Antimuscarinics and β-3 agonists can be used as adjective therapy for those with OAB who do not improve with behavioral therapy. β-3 agonists have less anticholinergic side effects compared with antimuscarinics for OAB. Adverse medication effects can often lead to discontinuation due to poor tolerability. Third-line therapies are for those who fail conservative and pharmacologic therapies and lack high-grade evidence. Neuromodulation, neurotoxin injections, vaginal laser therapy, and acupuncture are third-line in OAB management. Pharmacologic management with α-1-blockers is recommended as first-line treatment for moderate to severe overflow incontinence from BPH. 5-α reductase inhibitors can be used as an adjunct medication in those with refractory overflow incontinence symptoms and a PSA ≥ 1.5 mg/dL. Clean intermittent catheterization is first-line therapy for neurogenic bladder but can increase risk of catheter-associated urinary tract infection. Clinicians should assess type of incontinence, patient goals, side effect profile, and tolerability to determine an individualized treatment plan for each patient.