Urinary incontinence: A gynaecologist's experience

Female urinary incontinence leads to significant morbidity, resulting in impaired quality of life and social and occupational life, and adversely affecting women's physical, psychological, sexual and domestic well-being. It is a distressing condition that affects a significant proportion of the population, with reported incidence rates of 15-30%. Of the 14% of the adult female population who are affected by stress incontinence, 61% have had the problem for more than 4 years and at least 25% have delayed seeking help for more than 5 years. This paper presents some of the causes of incontinence, of which genuine stress incontinence (GSI) and detrusor instability (DI) are by far the most common. With correct diagnosis and treatment, it is always possible to improve women's quality of life. There is a wide range of drugs for treating incontinence. These may be extended to include drugs acting specifically on the urethral sphincter and the reflex mechanism controlling sphincter tone, but these drugs are currently in Phase III clinical trials. Surgical techniques and materials for the treatment of stress incontinence continue to improve. These include slings, injectables, bulking agents and Burch colposuspension. Tension-free vaginal tape (TVT) has become widely available over the past 4-5 years, and published data show good results. (C) 2002 Elsevier Science B.V. All rights reserved.