Stress incontinence

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Anterior vaginal wall repair	Female urinary tract	Male urinary tract	Stress incontinence
Stress incontinence

Electrical stimulation therapy uses low-voltage electric current to stimulate and contract the correct group of muscles. The current is delivered using an anal or vaginal probe. The electrical stimulation therapy may be done at the doctor's office or at home. Treatment sessions usually last 20 minutes and may be done every 1 to 4 days. Newer techniques are being investigated, including one that uses a specially designed electromagnetic chair that causes the pelvic floor muscles to contract when the patient is seated.

Medicines tend to work better in patients with mild-to-moderate stress incontinence. They include:

• Antimuscarinic drugs block bladder contractions. Many doctors prescribe these types of drugs first.
• Alpha-adrenergic agonist drugs such as phenylpropanolamine and pseudoephedrine (common components of over-the-counter cold medications) help increase sphincter strength and improve symptoms in about 50% of patients. 
• Imipramine, a tricyclic antidepressant, works in a similar way to alpha-adrenergic drugs.

Estrogen therapy can be used to improve urinary frequency, urgency and burning in postmenopausal women, and the tone and blood supply of the urethral sphincter muscles. However, whether estrogen treatment improves stress incontinence is controversial. Women with a history of breast or uterine cancer should usually not use estrogen therapy for the treatment of stress urinary incontinence.

Surgical treatment is only recommended after the exact cause of the urinary incontinence has been determined. Different types of surgeries are outlined below.

COLLAGEN INJECTION

A minor surgical procedure called collagen periurethral injection may be recommended for treatment of male and female stress incontinence caused by urethral sphincter dysfunction. The collagen makes the area around the urethra thicker, which helps control the urine leakage. This procedure is done in an outpatient setting, with a local or spinal anesthesia. The procedure may need to be repeated after a few months to achieve bladder control. Women treated with collagen injection therapy reported higher success rates than men. Potential complications include infection, urine retention, and temporary erectile dysfunction in men. Some people may have a potentially serious allergic reaction to collagen. Any potential candidate for collagen injection must have an allergy skin test prior to treatment.