Conservative Management of Stress Urinary Incontinence in Women

Although behavioral and surgical therapies are currently the mainstay of treating stress urinary incontinence (SUI), medications to treat SUI may possibly become first-line therapy. Currently, there are no medications approved by the US Food and Drug Administration that are indicated for SUI. However, results are becoming available on duloxetine, an oral medication that appears to be clinically safe and efficacious for the treatment of SUI. In addition to discussing medications currently under development, we will also discuss exciting pharmacologic targets that may be suitable for the treatment of SUI. Biofeedback also has demonstrated promise as an aid to the management of SUI, and many clinicians who treat SUI routinely incorporate this intervention into their therapeutic strategies. Pelvic floor muscle training remains a useful therapy for virtually all patients with SUI. Bladder retraining has demonstrated some promise, and its role in therapy continues to evolve. (Adv Stud Med. 2003;3(10D):S1052-S1059) M illions of women suffer from urinary incontinence, often in silence. In the United States, urinary incontinence affects an estimated 25 million women. The number of patients with stress urinary incontinence (SUI) is expected to rise dramatically as women in the “baby boom” generation age. SUI can cause unnecessary social isolation, and disposable products to manage urinary incontinence can be quite costly over the long term. The annual direct cost of care for women with urinary incontinence in the United States was estimated to be $12.4 billion in 1995. The predominant costs involve management measures, such as pads and diapers, not treatment measures. The primary etiologic factor of SUI is vaginal parity, usually due to a combination of muscular, nerve, and connective-tissue injuries. Many clinicians have considered SUI to be a purely anatomical deficit and therefore have not been enthusiastic about the potential of pharmacologic therapy. However, due to innovative basic and clinical research, new pharmacologic options are being studied.