The treatment of urinary incontinence in women should start with conservative measures that depend on what kind of incontinence they have, according to new guidelines from the American College of Physicians.
Women with stress urinary incontinence (marked by an inability to hold urine when laughing, coughing, or sneezing) should start with pelvic floor muscle training, sometimes called Kegel exercises.
Women who have urgency urinary incontinence (involuntary loss of urine associated with a sudden and compelling urge to void) should start with bladder training that aims to extend the time between voiding.
Women whose urinary incontinence is a mix of stress and urgency urinary incontinence should try pelvic floor muscle training and bladder training.
The final recommendation advises weight loss and exercise, which have been shown to improve urinary incontinence in obese women without harming them.
To be judged successful, treatment has to reduce the episodes of urinary incontinence by at least half.
“If these therapies do not work, then try pharmacologic therapies for urgency urinary incontinence,” Dr. Amir Qaseem from the American College of Physicians advised in an email to Reuters Health.
But, Qaseem added, drugs “do not work in stress urinary incontinence, and we recommend against it.”
The guideline, published in Annals of Internal Medicine, does not cover what to do when these approaches do not work.
“I think there is a need for more data to evaluate comparative effectiveness and cost effectiveness of surgery versus non-surgical interventions,” Qaseem said. “Having said that, I would say that once you have tried conservative treatment and it did not work, (certain people) may benefit with surgery."
Women considering surgery, Qaseem continued, need to consider the extent to which their symptoms are bothering them, plus the possible success of the surgery versus the possible harms.
Qaseem advised women to talk with their physicians about the side effects of various medications used to treat urgency or mixed urinary incontinence, because they all have similar effectiveness.
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