Urinary incontinence: Primary care therapies for the older woman Part two of a roundtable discussion

Work-up of the older woman with urinary incontinence includes a complete ph ysical, pelvic and rectal examinations, and a neurologic exam. The primary care physician can usually leave post-void residual testing to the speciali st. Lab tests include urinalysis and urine culture, as well as basic blood tests. If the patient is referred, the specialist may do other testing, suc h as urodynamics or cystometry. The choice of therapy depends on the cause and severity of each patient's symptoms. Primary care treatment options for mild to moderate incontinence include pelvic muscle exercises, bladder ret raining, and biofeedback-all of which can be taught by a physical therapist . Other noninvasive treatments include estrogen replacement therapy and ant icholinergic and other drug therapies.