Medical management of urinary incontinence in women

ELIM SHIH, MD
Center for Specialized Women’s Health, Cleveland Clinic

HEATHER HIRSCH, MD
The Ohio State University Wexner Medical Center, Columbus

HOLLY L. THACKER, MD, FACP, NCMP, CCD
Director, Center for Specialized Women’s Health, Department of Obstetrics and Gynecology, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

KEY POINTS

  1. The 3 types of urinary incontinence are stress, urgency, and mixed.
  2. The American College of Physicians (ACP) recommends weight loss and exercise for obese women with any of the 3 types of urinary incontinence.
  3. Pelvic floor muscle training has a strong ACP recommendation for stress incontinence, bladder training has a weak recommendation for urgency incontinence, and the combination of both has a strong recommendation in mixed incontinence.
  4. Drug treatment has a strong ACP recommendation for urgency incontinence if bladder training is unsuccessful, whereas the recommendation is against drug treatment for stress incontinence.

URINARY INCONTINENCE can lead to a cascade of symptomatic burden on the patient, causing distress, embarrassment, and suffering.

Traditionally, incontinence has been treated by surgeons, and surgery remains an option. However, more patients are now being managed by medical clinicians, who can offer a number of newer therapies. Ideally, a medical physician can initiate the evaluation and treatment and even effectively cure some forms of urinary incontinence.

In 2014, the American College of Physicians (ACP) published recommendations on the medical treatment of urinary incontinence in women.

This review describes the medical management of urinary incontinence in women, emphasizing the ACP recommendations1 and newer over-the-counter options.

COMMON AND UNDERREPORTED

Many women erroneously believe that urinary incontinence is an inevitable consequence of aging and allow it to lessen their quality of life without seeking medical attention.

Indeed, it is common. The 2005–2006 National Health and Nutritional Examination Survey found the prevalence of urinary incontinence in US women to be 15.7%. The prevalence increases with age from 6.9% in women ages 20 through 29 to 31.7% in those age 80 and older. A separate analysis of the same data found that 25.0% of women age 20 and older had 1 or more pelvic floor disorders. Some estimates are even higher. Wu et al reported a prevalence of urinary incontinence of 51.1% in women ages 31 through 54.

Too few of these women are identified and treated, for many reasons, including embarrassment and inadequate screening. Half of women with urinary incontinence do not report their symptoms because of humiliation or anxiety.

The burden of urinary incontinence extends beyond the individual and into society. The total cost of overactive bladder and urgency urinary incontinence in the United States was estimated to be $65.9 billion in 2007 and is projected to reach $82.6 billion in 2020.


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