4 ways to fight urinary incontinence

A new evidence-based clinical practice guideline from the American College of Physicians (ACP) recommends four alternatives to surgery for women with urinary incontinence (UI):

• Kegel exercises—a form of pelvic floor muscle training and strengthening that involves relaxing and tightening the muscles that control urine flow,
• bladder training—a form of behavioral therapy that involves urinating on a set schedule and gradually increasing the time between urination,
• weight loss and
• exercise.

"Urinary incontinence is a common problem for women that is often underreported and underdiagnosed," says David Fleming, MD, president of the organization for internal medicine physicians. Menopause, hysterectomy, obesity, urinary tract infections, functional and/or cognitive impairment, chronic cough and constipation are among the risk factors for the condition.

• For women with stress UI (the inability to retain urine when laughing, coughing or sneezing), the guideline calls for Kegel exercises and does not recommend 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 ACP suggests bladder training. If bladder training is unsuccessful, then the ACP recommends medication, which should be prescribed based on adverse effects and tolerability, ease of use and cost.
• For mixed UI, a combination of stress and urgency incontinence, the guideline calls for Kegel exercises with bladder training.
• For obese women with UI, the ACP recommends weight loss and exercise.

"Physicians should utilize non-drug treatments as much as possible for urinary incontinence," Fleming says. "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 44 to 57 percent of women aged 40 to 60 years and 75 percent of women aged 75 or more, according to the ACP, which notes that these estimates may be low because one study showed that at least half of incontinent women do not report the issue to a physician.

The ACP's guideline, "Nonsurgical Management of Urinary Incontinence in Women," was published today in Annals of Internal Medicine, the organization's flagship journal. It is based on published literature in the English language on nonsurgical management of UI in women from 1990 through December 2013. The 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 its members, who are primary care physicians.

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