A 40-year-old G3P3 complains of urge hesitancy. Further some- times she gets the urge to void, but passes urine before reaching washroom. She had three normal spontaneous vaginal deliveries of infants weighing between 3.5 and 3.8 kg. Urine examination is normal. All of the following are appropriate treatments in the management of this patient except?

This patient’s presentation is most consistent with urge incontinence. Urge incontinence is the involuntary loss of urine associated with a strong desire to void. Most urge incontinence is caused by detrusor or bladder dyssynergia in which there is an involuntary contraction of the bladder during distension with urine. The management of urge incontinence includes bladder training, biofeedback, or medical therapy. Treatment with anticholinergic drugs (oxybutynin chloride), β-sympathomimetic agonists (metaproterenol sulfate), Valium, antidepressants (imipramine hydrochloride), and dopamine agonists (Parlodel) has been successful. These pharmacologic agents will relax the detrusor muscle. In postmenopausal women who are not on estrogen replacement therapy, estrogen therapy may improve urinary control. Kegel exercises may strengthen the pelvic musculature and improve bladder control in women with stress urinary incontinence.