Management of urinary incontinence in women: scientific review.

ContextUrinary incontinence is a common health problem among women that negatively impacts quality of life. Therefore, it is important that primary care physicians have an understanding of how to manage urinary incontinence effectively.ObjectiveTo review the most recent, high-quality evidence regarding the etiology and management of urinary incontinence in women.Data Sources and Study SelectionSearches of MEDLINE, EMBASE, The Cochrane Library, and the ACP Journal Club were performed to identify English-language articles published between 1998-2003 that focused on the etiology or treatment of urinary incontinence in adult women. The references of each retrieved article were reviewed and an expert in the field was contacted to identify additional relevant articles.Data ExtractionUsing a combination of more than 80 search terms, we included articles of etiology that were cohort studies, case-control studies, cross-sectional studies, or systematic reviews of cohort, case-control, and/or cross-sectional studies. Studies of treatment had to be randomized controlled trials or systematic reviews of randomized controlled trials. The quality of each article was assessed independently by each author and inclusion (n = 66) was determined by consensus.Data SynthesisMultiple factors have been found to be associated with urinary incontinence, some of which are amenable to modification. Factors associated with incontinence include age, white race, higher educational attainment, pregnancy-related factors, gynecological factors, urological and gastrointestinal tract factors, comorbid diseases, higher body mass index, medications, smoking, caffeine, and functional impairment. There are several effective nonpharmacological treatments including pelvic floor muscle training, electrical stimulation, bladder training, and prompted voiding. Anticholinergic drugs are effective in the treatment of urge urinary incontinence. Several surgical interventions are effective in the management of stress incontinence, including open retropubic colposuspension and suburethral sling procedure.ConclusionUrinary incontinence in women is an important public health concern, and effective treatment options exist.

[1]  C. Glazener,et al.  Anterior vaginal repair for urinary incontinence in women. , 2017, The Cochrane database of systematic reviews.

[2]  P. Herbison,et al.  Weighted vaginal cones for urinary incontinence. , 2013, The Cochrane database of systematic reviews.

[3]  R. Pickard,et al.  Periurethral injection therapy for urinary incontinence in women. , 2007, The Cochrane database of systematic reviews.

[4]  G. P. Herbison,et al.  Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. , 2006, The Cochrane database of systematic reviews.

[5]  A. Wein.  Duloxetine vs Placebo in the Treatment of Stress Urinary Incontinence: A Four-Continent Randomized Clinical Trial , 2004 .

[6]  K. Williams,et al.  Bladder training for urinary incontinence in adults. , 2004, The Cochrane database of systematic reviews.

[7]  D. Roth,et al.  Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women: a randomized controlled trial. , 2003, JAMA.

[8]  A. Wein.  Pelvic floor muscle training for urinary incontinence in women. , 2002, The Journal of urology.

[9]  Linda Brubaker,et al.  Urinary Incontinence Predictors and Life Impact in Ethnically Diverse Perimenopausal Women , 2002, Obstetrics and gynecology.

[10]  O. Airaksinen,et al.  Increase in pelvic floor muscle activity after 12 weeks' training: a randomized prospective pilot study. , 2002, Urology.

[11]  M. Cesari,et al.  Benzodiazepines and the risk of urinary incontinence in frail older persons living in the community , 2002, Clinical pharmacology and therapeutics.

[12]  D. Roth,et al.  Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. , 2002, JAMA.

[13]  A. Kaider,et al.  Drug Therapy of Urinary Urge Incontinence: A Systematic Review , 2002, Obstetrics and gynecology.

[14]  T. Fjørtoft,et al.  Effect of Adding Biofeedback to Pelvic Floor Muscle Training to Treat Urodynamic Stress Incontinence , 2002, Obstetrics and gynecology.

[15]  H. Wong,et al.  A randomized controlled trial of tolterodine and oxybutynin on tolerability and clinical efficacy for treating Chinese women with an overactive bladder , 2002, BJU international.

[16]  H. Van Oyen,et al.  URINARY INCONTINENCE IN BELGIUM; PREVALENCE, CORRELATES AND PSYCHOSOCIAL CONSEQUENCES , 2002, Acta clinica Belgica.

[17]  Charles Kooperberg,et al.  Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. , 2002, JAMA.

[18]  M. Fall,et al.  The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. , 2002 .

[19]  P. Norton,et al.  Duloxetine versus placebo in the treatment of stress urinary incontinence. , 2002, American journal of obstetrics and gynecology.

[20]  P. Langenberg,et al.  Urinary incontinence and hysterectomy in a large prospective cohort study in American women. , 2002, The Journal of urology.

[21]  S. Stanton,et al.  Efficacy, Safety, and Tolerability of Extended‐Release Once‐Daily Tolterodine Treatment for Overactive Bladder in Older versus Younger Patients , 2002, Journal of the American Geriatrics Society.

[22]  G. Naglie,et al.  A randomized, double-blind, placebo controlled crossover trial of nimodipine in older persons with detrusor instability and urge incontinence. , 2002, The Journal of urology.

[23]  A. Heintz,et al.  The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms , 2002, BJOG : an international journal of obstetrics and gynaecology.

[24]  G. Rørtveit,et al.  Age‐ and Type‐Dependent Effects of Parity on Urinary Incontinence: The Norwegian EPINCONT Study , 2001, Obstetrics and gynecology.

[25]  D. Myers,et al.  Risk of new-onset urinary incontinence after forceps and vacuum delivery in primiparous women. , 2001, American journal of obstetrics and gynecology.

[26]  S. Furner,et al.  Urinary Incontinence in Wisconsin Skilled Nursing Facilities , 2001, Journal of aging and health.

[27]  K. Bø,et al.  Prevalence of stress and urge urinary incontinence in elite athletes and controls. , 2001, Medicine and science in sports and exercise.

[28]  A. Heintz,et al.  Does mode of hysterectomy influence micturition and defecation? , 2001, Acta obstetricia et gynecologica Scandinavica.

[29]  L. Dennerstein,et al.  Is Incontinence Associated With Menopause? , 2001, Obstetrics and gynecology.

[30]  H. Bruschini,et al.  Suburethral sling operations for urinary incontinence in women. , 2001, The Cochrane database of systematic reviews.

[31]  L. Viktrup,et al.  The risk of stress incontinence 5 years after first delivery. , 2001, American journal of obstetrics and gynecology.

[32]  G. Davila,et al.  A short-term, multicenter, randomized double-blind dose titration study of the efficacy and anticholinergic side effects of transdermal compared to immediate release oral oxybutynin treatment of patients with urge urinary incontinence. , 2001, The Journal of urology.

[33]  K. Newton,et al.  The second stage of labor and stress urinary incontinence. , 2001, American journal of obstetrics and gynecology.

[34]  S. Madersbacher,et al.  Risk Factors for Urinary Incontinence in Both Sexes , 2001, European Urology.

[35]  B. Shaffu,et al.  Tolterodine: superior tolerability than and comparable efficacy to oxybutynin in individuals 50 years old or older with overactive bladder: a randomized controlled trial. , 2001 .

[36]  R. Dmochowski,et al.  Prospective randomized controlled trial of extended-release oxybutynin chloride and tolterodine tartrate in the treatment of overactive bladder: results of the OBJECT Study. , 2001, Mayo Clinic proceedings.

[37]  A. Felling,et al.  The effects of physiotherapy for female urinary incontinence: individual compared with group treatment , 2001, BJU international.

[38]  K. Svärdsudd,et al.  Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old. , 2000, American journal of obstetrics and gynecology.

[39]  G. Lose,et al.  Risk Factors for Lower Urinary Tract Symptoms in Women 40 to 60 Years of Age , 2000, Obstetrics and gynecology.

[40]  D. Grady,et al.  Hysterectomy and urinary incontinence: a systematic review , 2000, The Lancet.

[41]  M. Freedman,et al.  Vitamin B12 deficiency and incontinence in older people. , 2000, The Canadian journal of urology.

[42]  F. Pesce,et al.  Prevalence of urinary incontinence among institutionalized patients: a cross-sectional epidemiologic study in a midsized city in northern Italy. , 2000, Urology.

[43]  D. Myers,et al.  Dietary Caffeine Intake and the Risk for Detrusor Instability: A Case‐Control Study , 2000, Obstetrics and gynecology.

[44]  B. Roe,et al.  An evaluation of a new pattern of electrical stimulation as a treatment for urinary stress incontinence: a randomized, double-blind, controlled trial , 2000, Clinical rehabilitation.

[45]  C. Davis,et al.  The Association of Depressive Symptoms and Urinary Incontinence Among Older Adults , 2000, Journal of the American Geriatrics Society.

[46]  A. Victor,et al.  Determinants of urinary incontinence in a population of young and middle‐aged women , 2000, Acta obstetricia et gynecologica Scandinavica.

[47]  R. Sakakibara,et al.  Randomized, double-blind study of electrical stimulation for urinary incontinence due to detrusor overactivity. , 2000, Urology.

[48]  F. Parazzini,et al.  Prevalence and Risk Factors for Urinary Incontinence in Italy , 2000, European Urology.

[49]  V. Kalia,et al.  Antenatal prediction of postpartum urinary and fecal incontinence. , 1999, Obstetrics and gynecology.

[50]  D. McClish,et al.  Comparative Efficacy of Behavioral Interventions in the Management of Female Urinary Incontinence , 1999 .

[51]  D. Kuh,et al.  Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. , 1999, Journal of epidemiology and community health.

[52]  A. Herzog,et al.  Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Heart & Estrogen/Progestin Replacement Study (HERS) Research Group. , 1999, Obstetrics and gynecology.

[53]  T. Raghunathan,et al.  Prevalence and severity of urinary incontinence in older African American and Caucasian women. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[54]  D. Lekan-Rutledge.  Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. , 1999, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[55]  S. Sereika,et al.  Effectiveness of Behavioral Therapy to Treat Incontinence in Homebound Older Adults , 1999, Journal of the American Geriatrics Society.

[56]  J. Djurhuus,et al.  Prevalent urinary incontinence as a correlate of pregnancy, vaginal childbirth, and obstetric techniques. , 1999, American journal of public health.

[57]  D. McClish,et al.  Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. , 1998, American journal of obstetrics and gynecology.

[58]  J. Lessing,et al.  Double‐blind, placebo‐controlled study of magnesium hydroxide for treatment of sensory urgency and detrusor inst ability: preliminary results , 1998 .

[59]  G. DeFriese,et al.  The Association of Urinary Incontinence with Poor Self‐Rated Health , 1998, Journal of the American Geriatrics Society.

[60]  D. Thom.  Variation in Estimates of Urinary Incontinence Prevalence in the Community: Effects of Differences in Definition, Population Characteristics, and Study Type , 1998, Journal of the American Geriatrics Society.

[61]  S. Hunskaar,et al.  Prevalence, 1-year incidence and factors associated with urinary incontinence: a population based study of women 50-74 years of age in primary care. , 1998, Maturitas.

[62]  S. Harkins,et al.  Psychosocial Impact of Urinary Incontinence in the Community‐Dwelling Population , 1990, Journal of the American Geriatrics Society.

[63]  A. Herzog,et al.  Prevalence and Incidence of Urinary Incontinence in Community‐Dwelling Populations , 1990, Journal of the American Geriatrics Society.

[64]  J. Yarnell,et al.  The prevalence and severity of urinary incontinence in women. , 1981, Journal of epidemiology and community health.

[65]  G. Herbison,et al.  Laparoscopic colposuspension for urinary incontinence in women. , 2006, The Cochrane database of systematic reviews.

[66]  R. Pickard,et al.  Adrenergic drugs for urinary incontinence in adults. , 2005, The Cochrane database of systematic reviews.

[67]  M. Finkelstein.  Medical conditions, medications, and urinary incontinence. Analysis of a population-based survey. , 2002, Canadian family physician Medecin de famille canadien.

[68]  C. Glazener,et al.  Bladder neck needle suspension for urinary incontinence in women. , 2002, The Cochrane database of systematic reviews.

[69]  P. Herbison,et al.  Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. , 2002, The Cochrane database of systematic reviews.

[70]  M. Choo,et al.  Tolterodine: As effective but better tolerated than oxybutynin in Asian patients with symptoms of overactive bladder , 2002 .

[71]  J. Langlois,et al.  Prevalence rate of urinary incontinence in community-dwelling elderly individuals: the Veneto study. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[72]  Patricia E. Lee,et al.  Periurethral autologous fat injection as treatment for female stress urinary incontinence: a randomized double-blind controlled trial. , 2001, The Journal of urology.

[73]  B. Roe,et al.  Prompted voiding for the management of urinary incontinence in adults. , 2000, The Cochrane database of systematic reviews.

[74]  A. C. Primavesi.  ? Obstetric Risk Factors for Stress Urinary Incontinence: A Population-Based Study , 2000 .

[75]  S. Madersbacher,et al.  Urinary incontinence in both sexes: Prevalence rates and impact on quality of life and sexual life , 2000, Neurourology and urodynamics.

[76]  W. Brown,et al.  Leaking urine: Prevalence and associated factors in Australian women , 1999, Neurourology and urodynamics.