The evaluation and treatment of urinary incontinence in women: a primary care approach.

BACKGROUND Urinary incontinence, the involuntary loss of urine severe enough to have adverse social or hygienic consequences, is a major clinical problem and a significant cause of disability and dependency. At least 10 million adults in the US suffer from urinary incontinence, including an estimated 15 to 30 percent of community-dwelling older persons. In spite of its high rate of occurrence, fewer than one-half of women with regular urinary incontinence seek medical help for their problem, either because of embarrassment or the perception that their symptoms are normal. METHODS MEDLINE files were searched from 1970 to 1990 using the key words "incontinence," "prevalence," and "diagnosis" and for specific nonsurgical treatments. Only articles pertaining to adult women were chosen. RESULTS AND CONCLUSIONS Urinary incontinence frequently can be diagnosed accurately by family physicians using basic tests in the office. Many women experience improvement of incontinence with properly employed behavioral and pharmacologic therapy. Other women benefit from referral for specialized evaluation and consideration for surgical therapy.