Further treatment options for the different types of incontinence
Stress incontinence
Light stress incontinence can be treated conservatively through physiotherapeutic exercises which strengthen the abdominal wall, pelvic floor and diaphragm musculature. Α-adrenergic drugs (midodrine, ephedrine, sympatol etc.), which reduce the tonus of the urethra, or if required estrogen substitution are available for drug therapy.
An operation is indicated when conservative treatment methods were not able to improve the symptoms sufficiently. There are many different surgical methods which aim at reconstructing the functionally significant proximal urethra:
• Needle suspension according to Stamey or Raz • Colposuspension • Sling operation • Collagen injection • Artificial urethral sphincter
Urge incontinence
For the therapy of patients with urge incontinence, it is necessary to identify and rule out primarily those factors which could cause urge incontinence. These factors include for example:
• Urinary tract infections (e.g. treatment with antibiotics) • Infravesical obstructions (e.g. surgical removal through transurethral procedures)
Neuromodulation of functional sacral nerves through electrostimulation as well as bladder augmentation and replacement as ultimate treatment methods for functionally and structurally reduced bladder capacity are further surgical treatment methods for urge incontinence.
Medicinal treatment options which curb detrusor muscle hyperactivity:
The cause of incontinence must always be established prior to therapy in case of patients who suffer from overflow incontinence. If incontinence is triggered by an enlarged prostate or a tumor, a procedure on the urethra is necessary to remove the obstruction.
Reflex incontinence
The best method of emptying the bladder voluntarily in reflex incontinence is intermittent autocatheterism.
Extra-urethral incontinence
Extra-urethral incontinence can be treated only by an operation.
