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Behavioral therapy generally best for urinary incontinence

While most nonpharmacologic and pharmacologic interventions are more likely to improve outcomes of stress or urgency urinary incontinence in women than no treatment, behavioral therapy, alone or combined with other interventions, was more effective than pharmacologic therapies alone, according to research published in Annals of Internal Medicine.

“Urinary incontinence, the involuntary loss of urine, affects about 17% of nonpregnant women, and its prevalence increases with age, particularly after menopause,” Ethan M. Balk, MD, MPH, associate professor at Brown University, and colleagues wrote. “Incontinence may have a negative effect on a woman’s physical, psychological, and social well-being and may impose substantial lifestyle restrictions.”

Balk and colleagues performed a systematic review and network meta-analysis of 84 randomized trials to determine the effectiveness of pharmacologic vs. nonpharmacologic interventions in improving or curing stress, urgency or mixed urinary incontinence in nonpregnant women. The included studies assessed 14 different types of interventions and reported cure or improvement outcomes.

Behavioral therapies, anticholinergics and neuromodulation were the most frequently assessed active intervention types. Other interventions included neuromodulation, hormones, intravesical pressure release, periurethral bulking, alpha-agonists, onabotulinum toxin A, antiepileptics and adrenergic agonists, as well as combinations of these interventions.

The meta-analysis indicated that all interventions studied, with the exception of hormones and periurethral bulking agents due to varying strength of evidence, achieved at least one favorable urinary incontinence outcome more effectively than no treatment.

Behavioral therapy was more effective at curing or improving stress urinary incontinence than alpha-agonists and hormones. Alpha-agonists demonstrated more effectiveness in improving stress urinary incontinence than hormones. Additionally, neuromodulation cured and improved stress urinary incontinence and satisfied patients better than no treatment.

For urgency urinary incontinence, achieving cure or improvement was statistically significantly more effective with behavioral therapy treatment. Neuromodulation and onabotulinum toxin A demonstrated greater effectiveness than no treatment for urgency urinary incontinence. Treatment with onabotulinum toxin A was associated with greater effectiveness in achieving cure for urgency urinary incontinence than neuromodulation.

“Most nonpharmacologic and pharmacologic interventions are more likely than no treatment to improve urinary incontinence outcomes,” Balk and colleagues concluded. “Behavioral therapy, alone or in combination with other interventions, is generally more effective than pharmacologic therapies alone in treating both stress and urgency urinary incontinence.” – by Alaina Tedesco

Disclosures: The authors report receiving a grant from AHRQ.