[Female incontinence: work-up and therapy]

Female incontinence is a more frequent disorder than sometimes realized. The patient should be asked about urinary incontinence symptoms. Depending on her degree of suffering, the appropriate diagnostic examinations and therapy can be chosen. With simple procedures, such as anamnesis, gynecological examination with testing, Valsalva maneuver with a full bladder, and a review of miction diaries, the kind of incontinence can be reliably determined, and first therapeutic steps can be initiated. For stress incontinence this would be pelvic floor reeducation or physical therapy with electric stimulation and bio-feed-back; only if these conservative measures fail, one should operate. For urge incontinence, it is important to strive for a change in drinking and miction habits (bladder training), i.e., to increase the amount of liquid intake and the miction volume (checked by miction diaries). This therapy can be further supported by medication. Urodynamic diagnostic examinations are indicated when primary therapy (pelvic floor reeducation, bladder training) fails, before any incontinence operation and when the type of incontinence is not clear.