What nonsurgical treatments are available for urinary incontinence? What surgical treatments are the least invasive and with lowest recovery time? How effective are these options, and how many years do they last? What complications are there?

W.

There's a host of options for dealing with urinary incontinence, some surgical and some not. Determining which options are best depends on exactly what type of incontinence is present -- stress (leaking with coughing, sneezing, exercise); urge (leaking when you feel you need to urinate); detrusor instability (leaking due to spasms of the bladder-wall muscle); or overflow (leaking because the bladder gets too full, usually associated with some type of nerve damage). Leakage may also result from a condition called intrinsic sphincter deficiency, in which the junction between bladder and urethra does not function properly.

Stress incontinence may be treated with Kegel exercises, biofeedback or surgery. Surgical approaches are many, and may involve a vaginal, abdominal or laparoscopic approach. Urge incontinence and detrusor instability are usually treated with medications, while overflow is helped by emptying the bladder on a regular basis by the clock. Intrinsic sphincter deficiency is treated either by a surgical sling procedure or by injections of collagen into the urethra.

Because incontinence has so many potential causes, treatments must be individualized. You need a thorough work-up to determine the best approach in your case. Your own doctor is best able to answer your specific questions. In complicated cases, or in cases in which surgery has failed, you may need to see a urogynecologist, a specialist who handles female incontinence and pelvic support defects.