MEDICAL-TREATMENT OF FEMALE URINARY-INCON TINENCE

Urinary incontinence is a frequently encountered and highly disabilita ting disorder in women, especially after menopause. Several causes, so metimes associated, have been identified. After menopause, lower oestr ogen levels lead to general cellular, biochemical, bacteriological and anatomic modifications in the urinary tract resulting in vaginal atro phy, diminished sphincter tone and increased bladder sensitivity. Trea tment should always be based on results of urodynamic studies and adap ted to the aetiologic diagnosis and patient demands. Medical treatment is usually associated with behavioural and physical therapy technique s. Drugs with an effect on Madder instability include: parasympathicol ytic or anticholinergic agents which lower bladder pressure by inhibit ing bladder receptors; tricyclic antidepressors for their central and peripheral anticholinergic effects; non-steroid anti-inflammatory agen ts which decrease uretral tone; antispasmodics; and oestrogens in meno paused women. Beta-mimetics, calcium inhibitors, opioids and myorelaxa nts are also used but in a limited number of cases due to side effects . Urethral instability may respond to tetracycline in case of infectio n or non-steroid antiinflammatory drugs. Oestrogens play an important role in improving urethral trophicity and sensitive response to alpha- stimulants. Surgery may be indicated in a limited number of specific c ases.