Annual urinary incontinence screening recommended for women

The Women’s Preventive Services Initiative recently recommended screening women for urinary incontinence annually, and screening should assess if urinary incontinence affects quality of life and activities. If indicated, physicians should refer women for further evaluation and treatment.

In a systematic review published in Annals of Internal Medicine, researchers found “insufficient” evidence for the effectiveness and harms of screening for urinary incontinence in women. They did find limited evidence in general populations suggesting “fairly high accuracy” for some screening methods.

“The [Women’s Preventive Services Initiative] selects topics that fill gaps in existing screening and prevention guidelines and that meet eligibility criteria. Criteria include conditions that affect a broad population of women; that are specific, more common, more serious, or differ in women; and for which prevention would have a large potential effect on women's health and well-being,” Nancy O’Reilly, MHS, of the American College of Obstetricians and Gynecologists (ACOG), and colleagues wrote.

Data suggest about one in four reproductive-aged women, approximately three in four older women and about half of postmenopausal and middle-aged women experience some involuntary urine loss, according to the report.

“Additional criteria require that the health service be a primary or secondary prevention service feasible for practice in the United States, including screening, counseling, immunization, and preventive medication or therapy, and that the quality and strength of evidence directly or indirectly support its effectiveness,” O’Reilly and colleagues added.

They added that the Initiative followed a process similar to the U.S. Preventive Services Task Force to develop the recommendations and has an advisory panel made up of members of the American Academy of Family Physicians, American College of Physicians, ACOG and others to steer the recommendation process.

In a related editorial, Robin J. Bell, MBBS, PhD, MPH and Susan R. Davis, MBBS, PhD of Monash University in Melbourne, Australia acknowledged that screening is “intuitively attractive.”

But they added that incontinence often resolves on its own and significant data lack on the condition, thus calling into question the importance of screening for it.

“Applying a screening test to a large population is a very serious responsibility. If screening were associated with even a small amount of harm and the proportion of women who would benefit from early identification were modest, then the net benefit might be marginal or negative. Therefore, we advocate caution in implementing the [Women’s Preventive Services Initiative] recommendation until there is direct evidence for a net benefit of annual screening for urinary incontinence,” they wrote. – by Janel Miller

References:

Bell RJ, Davis SR. Ann Intern Med. 2018;doi:10.7326/M18-1768.

Nelson HD, et al. Ann Intern Med. 2018;doi:10.7326/M18-0225.

O’Reilly N, et al. Ann Intern Med. 2018;doi:10.7326/M18-0595.

Disclosure: O’Reilly reports receiving grants from the Health Services Resource Administration during the course of the research process. Please see the review, guidelines and editorial for all other authors’ relevant financial disclosures.