Pelvic floor muscle training, bladder training and weight loss and exercise are effective nonsurgical treatment options for women with urinary incontinence, according to a physician groups evidence-based clinical practice guideline.
About $19.5 billion was spent on UI care in 2004, and UI accounts for 6% of nursing home admissions for elderly women, costing about $3 billion, according to a news release from the American College of Physicians. The new guideline, written by the ACP, was published Sept. 16 in the Annals of Internal Medicine.
Urinary incontinence is a common problem for women that is often underreported and underdiagnosed, ACP President David Fleming, MD, said in a news release. Physicians should take an active approach and ask specific questions such as onset, symptoms and frequency of urinary incontinence. It is estimated that about half of the women with incontinence do not report it to their doctor.
According to evidence cited in the guideline, pelvic floor muscle training alone or with biofeedback improved urinary incontinence.
For women with stress UI (the inability to retain urine when laughing, coughing or sneezing), ACP recommends pelvic floor muscle training (Kegel exercises) and recommends against systemic drug therapy. For women with urgency UI (the loss of urine for no apparent reason after suddenly feeling the need or urge to urinate), the guideline recommends bladder training. If bladder training is unsuccessful, the ACP recommends medication. Physicians should choose a medication based on adverse effects and tolerability, ease of use and cost, the release said.
For mixed UI, a combination of stress and urgency incontinence, the ACP recommends pelvic floor muscle training with bladder training. The ACP recommends weight loss and exercise for obese women diagnosed with UI.
ACPs guideline includes advice to help physicians and patients understand the benefits, harms and costs of tests and treatment options so they can pursue care that improves health, avoids harms and eliminates wasteful practices.
Physicians should utilize nondrug treatments as much as possible for urinary incontinence, Fleming said in the release. Kegel exercises for stress UI, bladder training for urgency UI, and Kegel exercises with bladder training for mixed UI are effective, have few side effects, and are less expensive than medications. Although various drugs can improve UI and provide complete continence, adverse effects often lead many patients to stop taking their medication.
UI affects about 25% of women ages 14-21, 44% to 57% of women ages 40-60, and 75% of women ages 75 and older, according to past studies. These estimates may be low as one study showed at least half of incontinent women do not report the issue to their physician, according to the release.
Risk factors for UI include pregnancy, pelvic floor trauma after vaginal delivery, menopause, hysterectomy, obesity, urinary tract infections, functional and/or cognitive impairment, chronic cough and constipation.
ACPs recommendations are based on a review of published literature in the English language on nonsurgical management of UI in women from 1990 through December 2013. ACP did not evaluate surgical treatment options and some nonsurgical treatments, such as botulinum toxin, percutaneous nerve stimulation, magnetic stimulation or electrical stimulation, because these treatments are not typically used by or available to primary care physicians.
ACP guideline: http://annals.org/article.aspx?articleid=1905131