1990 Volume 81 Issue 11 Pages 1700-1705
We reviewed 115 incontinent women undergoing conservative treatment. Urinary incontinence was caused by pelvic floor weakness (genuine stress incontinence) in 54 patients, by involuntary detrusor contraction (detrusor instability) in 38 and by both (mixed type) in 23. Tricyclic antidepressants or alpha-adrenergic stimulators were given to 30 ptiaents with pelvic floor weakness; Incontinence disappeared in 4 patients (13%) and was improved in other 3 patients (10%). Twenty-two patients with pelvic floor weakness underwent pelvic floor exercise with or without medication; Incontinence disappeared in 8 patients (36%) and was improved in other 11 patients (50%); The presence or absence of medication did not affect the results. Twenty-eight patients with involuntary detrusor contraction underwent bladder training combined with medication of detrusor relaxants; Incontinence disappeared in 4 patients (14%) and was improved in other 13 patients (46%); There was no significant difference in the results between smooth muscle relaxants and tricyclic antidepressants. Of the 23 patients with mixed type, 11 underwent bladder training with medication; Incontinence disappeared in 2 patients (18%) and was improved in 3 patients (27%); The remaining 11 patients received medication, pelvic floor exercise or urethral dilatation, and only 2 patients were cured or improved of incontinence. Follow-up of the patients with involuntary detrusor contraction or mixed type showed that urinary incontinence tended to recur after discontinuation of medication. These results indicate that incontinent women with pelvic floor weakness should be treated first with pelvic floor exercise, and then with bladder training with medication. Although it has only a limited effect, it is an acceptable treatment of urinary incontinence caused by involuntary detrusor contraction.
