From the Guidelines
Treatment approaches for stress and urge incontinence differ significantly, with stress incontinence primarily treated with pelvic floor muscle exercises and surgical options like midurethral slings, while urge incontinence is treated with bladder training, fluid management, and medications like anticholinergics or beta-3 agonists. The most recent and highest quality study, published in 2025 in the European Urology journal 1, highlights the importance of distinguishing between stress and urge incontinence to provide effective treatment.
Key Differences in Treatment Approaches
- Stress incontinence is caused by weakened pelvic support structures, leading to leakage with physical pressure, and is treated with:
- Pelvic floor muscle training (Kegels) performed 3 sets of 10 contractions daily for at least 3 months
- Surgical options like midurethral slings (e.g., tension-free vaginal tape or transobturator tape) for urethral support
- Urge incontinence is caused by detrusor muscle overactivity, leading to sudden, strong urges to urinate, and is treated with:
- Bladder training with scheduled voiding every 2-3 hours and fluid management
- Medications like anticholinergics (e.g., oxybutynin, tolterodine, or solifenacin) or beta-3 agonists (e.g., mirabegron) to reduce bladder muscle contractions
Considerations for Treatment
The choice of treatment should be based on individual patient characteristics, preferences, and severity of symptoms, as well as the potential risks and benefits of each treatment option, as noted in the studies 1. Additionally, the most recent study 1 emphasizes the need for ongoing research to optimize outcomes and ensure patient safety, particularly for complicated stress urinary incontinence.
From the Research
Treatment Approaches for Stress and Urge Incontinence
The treatment approaches for stress incontinence and urge incontinence differ in several ways.
- Stress incontinence is often treated with pelvic floor muscle training, which can be done through various methods, including Internet-based programs 2 and behavioral therapies such as Kegel exercises and biofeedback 3.
- Urge incontinence, on the other hand, is typically treated with conservative therapy, which includes anticholinergic drugs, spasmolytics, estrogens, and tricyclic antidepressives 4.
- Lifestyle modifications, bladder training, and electrostimulation are also important components of conservative treatment for urge incontinence 4.
- Pelvic floor exercises have been shown to be effective in treating stress incontinence, but the success of this treatment depends on various factors, including the patient's ability to control their pelvic floor muscles 5.
Comparison of Treatment Outcomes
- Studies have shown that Internet-based treatment programs for stress incontinence can be highly effective, with significant improvements in symptom scores and condition-specific quality of life 2.
- Conservative therapy for urge incontinence has also been shown to be effective, although the success rate may vary depending on the individual patient and the specific treatment approach used 4.
- A study comparing the outcomes of pelvic floor exercises for stress incontinence found that patients who succeeded with this treatment had a higher degree of corticofugal control of their perineal muscles than those who did not benefit from the treatment 5.
Treatment Recommendations
- For stress incontinence, pelvic floor muscle training is often recommended as the first line of treatment, with surgical options considered if conservative treatment fails 3.
- For urge incontinence, conservative therapy is usually the preferred treatment approach, with anticholinergic drugs and lifestyle modifications being common treatment options 4, 6.
- Urologic referral may be necessary if initial treatment measures fail or if the patient has a complex case of incontinence, such as previous incontinence surgery or irradiation 6.