Try Multiple Strategies Simultaneously To Treat Stress Urinary Incontinence.

CHICAGO -- Shotgun approaches to the treatment of stress urinary incontinence are a surefire way to fail.

That's because no single modality can address enough aspects of this complex, multifactorial disorder, and, after several failed treatment attempts, patients are likely to refuse therapy all together, Dr. Karl M. Luber said at the annual meeting of the Central Association of Obstetricians and Gynecologists.

After ruling out some targeted causes of incontinence such as urinary tract infection, vaginal atrophy, and medicinal triggers, Dr. Luber, director of the section of urogynecology and pelvic reconstructive surgery at Kaiser Permanente, Southern California, San Diego, offered the following advice for averting treatment failure:

* Get the nitty-gritty. For the patient with poor eyesight and poor mobility, it's a good idea to get the details of her lifestyle such as where she lives, where the bathroom is in relation to her bed-room, whether there's a well-lit pathway to the bathroom, and whether she's afraid of getting up and going to the bathroom at night for fear of falling.

* Time diuretics. It may seem counterintuitive, but patients should take diuretics, such as Lasix (furosemide), at 4 or 5 p.m. instead of early in the morning. When patients take diuretics first thing in the day, their body has already had a chance to restore fluid by the time they're ready for bed, and they will need to void during the night. If diuretics are taken in the late afternoon, the drug will have a chance to work while the patient is still, awake, which will cause less disruption of sleep from the urge to eliminate ...