Clinical Review State of the Art Review

Urinary incontinence in women

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4531 (Published 15 September 2014) Cite this as: BMJ 2014;349:g4531
  1. Lauren N Wood, physician 1,
  2. Jennifer T Anger, associate professor of urology; associate director of urological research2
  1. 1Cedars-Sinai Medical Center, Department of Surgery, Division of Urology, Los Angeles, CA, USA
  2. 2Urologic Reconstruction, Urodynamics, and Female Urology, Cedars-Sinai Medical Center, Department of Surgery, Division of Urology, Los Angeles, CA 90211, USA
  1. Correspondence to: J T Anger jennifer.anger{at}cshs.org

Abstract

Urinary incontinence affects women of all ages. History, physical examination, and certain tests can guide specialists in diagnosing stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence. First line management includes lifestyle and behavior modification, as well as pelvic floor strength and bladder training. Drug therapy is helpful in the treatment of urgency incontinence that does not respond to conservative measures. In addition, sacral neuromodulation, intravesical onabotulinumtoxinA injections, and posterior tibial nerve stimulation can be used in select patient populations with drug refractory urgency incontinence. Midurethral synthetic slings, including retropubic and transobturator approaches, are safe and efficacious surgical options for stress urinary incontinence and have replaced more invasive bladder neck slings that use autologous or cadaveric fascia. Despite controversy surrounding vaginal mesh for prolapse, synthetic slings for the treatment of stress urinary incontinence are considered safe and minimally invasive.

Footnotes

  • Contributors: Both authors helped plan, conduct, and report the work. JTA is guarantor.

  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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