Refractory urge incontinence: Conservative, non-drug therapies

In patients with refractory urge incontinence, a variety of non-pharmacologic therapeutic options can be used as an alternative or complement to anticholinergic medications. Maximizing conservative measures, namely behavioral therapy and physical therapy, offers multiple benefits and adds little risk for the majority of patients.

A 67% reduction in the number of incontinent episodes per day would be a dramatic benefit to expect from a drug. This means someone who experienced three leaks per day would have only one leak as a result of treatment. Do you really believe that wetting your pants once per day sounds like a comfortable situation? How about once per week, once per month, or even once per year? It's clear that our "go-to" solution is less than satisfactory for many, including "successfully" treated patients.

These individuals have what I define as refractory urge incontinence, and this two-part discussion is a practical guide to how we can win the battle for those patients' urinary control. In this first article, I will summarize the non-drug conservative or first-line options, which can also be used as a complement to drug therapy if desired. In part two, I will detail the use of neuromodulation therapies and intravesical botulinum toxin (Botox) for the minority of patients who don't respond adequately.