Behavioral therapy, in the form of bladder
Pharmacologic agents may be given empirically to women with symptoms of overactive bladder. Table 3 lists the most common medications used to treat women with overactive bladder. It is important for patients to understand that there may
As with stress incontinence, ERT is also an effective treatment for women with overactive bladder. Even in patients taking systemic estrogen, localized ERT (i.e., estradiol-impregnated vaginal ring) may increase inadequate estrogen levels and decrease the symptoms associated with overactive bladder.
Likewise, pelvic floor electrical stimulation is also effective in treating women with overactive bladder. This procedure is widely used in Europe.
Neuromodulation of the sacral nerve roots through electrodes implanted in the sacral foramina is a promising new surgical treatment that has been found to be effective in the treatment of urge incontinence, urgency/frequency syndrome, urinary retention and even pelvic pain. Patients first undergo implantation of a temporary test stimulator. If a significant reduction in symptoms occurs, the permanent device is implanted one week later. Given the cost and invasive nature of this modality, it should be reserved for patients who do not respond to more conservative options.
The FDA has recently approved extracorporeal magnetic innervation, a noninvasive procedure for the treatment of incontinence caused by pelvic floor weakness. The patient sits fully clothed in a pulsating magnetic chair that stimulates the pelvic floor. A typical treatment session lasts approximately 20 minutes and includes high- and low-frequency stimulation.
Extracorporeal magnetic innervation may have a place in the treatment of women with both stress and urge incontinence.
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