Current treatment options for female urinary incontinence--a review.

Urinary incontinence is a prevalent condition that impacts many women's lives. Stress urinary incontinence (SUI), urine loss associated with exertion, typically has its onset during the reproductive years, whereas urge incontinence, urine loss associated with urgency, more frequently affects postmenopausal women. Mixed incontinence, a combination of stress and urge incontinence, affects up to 30% of incontinent women. Simple modifications such as dietary and fluid management, timed voiding, and adjustment of medications can lessen symptom severity and should be attempted prior to instituting other treatments. Physiotherapy, including pelvic floor exercises, biofeedback, and functional electrical stimulation, center on improving pelvic floor neuromuscular function, thus improving bladder and urethral function. Current pharmacologic treatments focus primarily on urge incontinence, anticholinergics being the mainstays of therapy. Local estrogen therapy may improve urethral and bladder function if a woman's incontinence is associated with urogenital atrophy. Surgery is primarily reserved for management of severe SUI. Minimally invasive sling procedures have replaced the Burch colposuspension as the most common surgeries performed for SUI, and appear to have similar success rates. Surgical therapies for refractory urge incontinence have been attempted with limited success. Many new, potentially more effective, treatments are being developed.