As a rule, patients can safely be treated using conservative modalities such a biofeedback, pelvic muscle stimulation and pessaries as long as urinary tract and vaginal infection have been ruled out and the potential for more serious problems such a stones, cancer and fistula is minimal.
One to two weeks before treatment is initiated, a questionnaire and voiding diary is sent out to the patient. At the initial appointment, the patient history, normal routine, coping mechanisms, medications and environmental barriers are reviewed. A thorough physical exam focuses on possible causes for the problem in the central nervous system, abdomen, vaginal vault and rectum.Gynecologists and urologists are available for consultation if there is a question regarding appropriate patient treatment. If there is a need for urodynamic testing or cystoscopy an appropriate referral is made.