Question

In patients with *GSI* (genuine stress incontinence); what are the best options for management if this is due to *urethral hypermobility* (straining Q-tip > 30 degrees from horizon)?

Answer 1

The best management options for stress incontinence due to urethral hypermobility include pelvic floor muscle exercises, behavioral changes, pessary use, and surgery.

Step-by-step explanation:

In patients with genuine stress incontinence due to urethral hypermobility, there are several management options available. These include:

1. Pelvic floor muscle exercises (Kegel exercises): These exercises help to strengthen the pelvic floor muscles and improve urethral support. They involve squeezing and releasing the muscles that control urination.
2. Behavioral changes: This includes modifying fluid intake, avoiding bladder irritants (such as caffeine or alcohol), and timed voiding (urinating on a schedule rather than waiting for the urge to go).
3. Pessary use: A pessary is a device that can be inserted into the vagina to provide support to the urethra and help reduce stress incontinence.
4. Surgery: In severe cases, surgical procedures can be considered to provide additional support to the urethra. These may include mid-urethral slings or urethral bulking agents.

It is important for patients to discuss these options with their healthcare provider to determine the most suitable management approach for their specific case.