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Am Fam Physician. 2009;79(5):409

Background: Urinary incontinence affects 19 to 30 percent of women, depending on age. Almost one third of these women have daily or severe symptoms that affect their quality of life and that may drive treatment decisions. Several organizations, including the Cochrane Collaboration, the International Consultation on Incontinence, and the Agency for Healthcare Research and Quality, have studied the effects of clinical interventions for urinary incontinence; most studies evaluated short-term curative treatments. Shamliyan and colleagues reviewed the evidence on nonsurgical interventions for urinary incontinence in community-dwelling women. The review was prepared as background information for a National Institutes of Health report.

The Study: The review included randomized, controlled, English-language trials published between 1990 and May 2007 that evaluated nonsurgical clinical interventions for urinary incontinence. Studies were excluded if they involved nursing home residents, long-term use of indwelling catheters or bedpans, or surrogate outcome markers as end points. Trial quality was evaluated by strength-of-evidence criteria. The primary outcome was long-term continence (i.e., six months or more).

Results: Of 248 randomized controlled trials, 96 were included in the review. Patients had stress, urge, or mixed incontinence; and interventions included pelvic floor muscle training, bladder training, electrical and magnetic stimulation, and medications. The studies were generally good quality, but were heterogeneous in interventions and reported outcomes. There was consistent evidence that pelvic floor muscle training combined with bladder training effectively resolved urinary incontinence in women, but the size of the effect varied among studies. Conversely, pelvic floor muscle training alone, with the assistance of a physical therapist or with biofeedback, was no more effective than other therapies. Electrical or magnetic stimulation was not effective for achieving long-term continence. Hormone therapy improved urge incontinence only when administered transdermally or intravaginally, and was not effective for stress incontinence. Oral hormone therapy worsened stress incontinence. Oxybutynin (Ditropan) and tolterodine (Detrol), the only anticholinergics studied, were moderately beneficial for urge incontinence compared with placebo.

Conclusion: The authors conclude that pelvic floor muscle training with bladder training leads to continence in women. However, most studies of nonsurgical treatments do not focus on long-term results, which should be the primary outcome in future studies.

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