Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-26T17:28:52.409Z Has data issue: false hasContentIssue false
  • English
  • Français

Non-pharmacological management of urinary incontinence

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  27 September 2010

A Mathur ,
J Browning  and
AK Mistri
A Mathur
Affiliation:
University of Leicester and Leicester General Hospital, UK
J Browning
Affiliation:
University of Leicester and Leicester General Hospital, UK
AK Mistri*
Affiliation:
University of Leicester and Leicester General Hospital, UK
*
Address for correspondence: Dr AK Mistri, Senior Lecturer, Ageing & Stroke Medicine, Department of Cardiovascular Sciences, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Urinary incontinence is a common and under-reported symptom, affecting one in five people, with a higher prevalence in women and those who are elderly. It can have a major impact on physical health and social activity. Initial assessment to categorize symptom type is the key to guiding further therapy. Non-pharmacological (NP) options are preferred as first-line intervention, and if unsuccessful, are followed by anticholinergics, often in combination with NP options. Surgical intervention must be sought where appropriate. However, NP interventions are often not considered due to uncertainty about the evidence-base, perceived difficulty of application and perhaps a lack of awareness of or access to specialist continence services. This article addresses the first of the barriers, summarizing the evidence for various NP interventions, including lifestyle interventions, physical therapies, behavioural therapies and containment options, enabling the reader to formulate an evidence-based opinion and a pragmatic view on the feasibility, efficacy and applicability of the various NP interventions, without automatic recourse to anticholinergic medication in the first instance.

Keywords

conservative managementoveractive bladderurinary incontinence
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 20 , Issue 4 , November 2010 , pp. 268 - 276
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Brown, JS, Vittinghoff, E, Wyman, JF, Stone, KL, Nevitt, MC, Ensrud, KE, Grady, D. Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc 2000; 48: 721–25.CrossRefGoogle ScholarPubMed
2Brown, JS, McGhan, WF, Chokroverty, S. Comorbidities associated with overactive bladder. Am J Manag Care 2000; 6 (suppl): S574–79.Google Scholar
3Wagner, TH, Hu, TW, Bentkover, J, LeBlanc, K, Stewart, W, Corey, R, Zhou, Z, Hunt, T. Health-related consequences of overactive bladder. Am J Manag Care 2002; 8 (suppl): S598–607.Google ScholarPubMed
4Turner, DA, Shaw, C, McGrother, CW, Dallosso, HM, Cooper, NJ. The cost of clinically significant urinary storage symptoms for community dwelling adults in the UK. BJU Int 2004; 93: 1246–52.CrossRefGoogle ScholarPubMed
5Mappilakkandy, R, Mistri, AK. Anticholinergics for urge incontinence. Rev Clin Gerontol 2010; 20: 30–41.CrossRefGoogle Scholar
6Kelleher, C, Cortes, E. Defining success in overactive bladder: the importance of patient-focused outcomes. BJOC 2006; 113 (suppl): 9–18.Google Scholar
7Asplund, R, Aberg, HE. Nocturia in relation to body mass index, smoking and some other life-style factors in women. Climacteric 2004; 7: 267–73.CrossRefGoogle ScholarPubMed
8Bradley, CS, Kennedy, CM, Nygaard, IE. Pelvic floor symptoms and lifestyle factors in older women. J Womens Health (Larchmt) 2005; 14: 128–36.CrossRefGoogle ScholarPubMed
9Dallosso, HM, McGrother, CW, Matthews, RJ, Donaldson, MM. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int 2003; 92: 69–77.CrossRefGoogle ScholarPubMed
10Roe, BH, Doll, H. Lifestyle factors and continence status: comparison of self-report data from a postal survey in England. J Wound, Ostomy Continence Nurs 1999; 26: 312–19.Google Scholar
11Hannestad, YS, Rortveit, G, Daltveit, AK, Hunskaar, S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG 2003; 110: 247–54.CrossRefGoogle ScholarPubMed
12Subak, LL, Wing, R, West, DS, Franklin, F, Vittinghoff, E, Creasman, JM, Richter, HE, Myers, D, Burgio, KL, Gorin, AA, Macer, J, Kusek, JW, Grady, D; PRIDE Investigators. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 2009; 360: 481–90.Google Scholar
13Bump, RC, Sugerman, HJ, Fantl, JA, McClish, DK. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol 1992; 167: 392–97.CrossRefGoogle ScholarPubMed
14Deitel, M, Stone, E, Kassam, HA, Wilk, EJ, Sutherland, DJ. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr 1988; 7: 147–53.CrossRefGoogle ScholarPubMed
15Burgio, KL, Richter, HE, Clements, RH, Redden, DT, Goode, PS. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol 2007; 110: 1034–40.CrossRefGoogle ScholarPubMed
16Creighton, SM, Stanton, SL. Caffeine: does it affect your bladder? Br J Urol 1990; 66: 613–14.CrossRefGoogle ScholarPubMed
17Arya, LA, Myers, DL, Jackson, ND. Dietary caffeine intake and the risk for detrusor instability: a case-control study. Obstet Gynecol 2000; 96: 85–89.Google ScholarPubMed
18Bryant, CM, Dowell, CJ, Fairbrother, G. Caffeine reduction education to improve urinary symptoms. Br J Nurs 2002; 11: 560–65.CrossRefGoogle ScholarPubMed
19Tomlinson, BU, Dougherty, MC, Pendergast, JF, Boyington, AR, Coffman, MA, Pickens, SM. Dietary caffeine, fluid intake and urinary incontinence in older rural women. Int Urogynecol J Pelvic Floor Dysfunct 1999; 10: 22–28.Google Scholar
20Wyman, JF, Elswick, RK, Wilson, MS, Fantl, JA. Relationship of fluid intake to voluntary micturitions and urinary incontinence in women. Neurourol Urodyn 2005; 10: 463–73.CrossRefGoogle Scholar
21Swithinbank, L, Hashim, H, Abrams, P. The effect of fluid intake on urinary symptoms in women. J Urol 2005; 174: 187–89.CrossRefGoogle ScholarPubMed
22Griffiths, DJ, McCracken, PN, Harrison, GM, Gormley, EA. Relationship of fluid intake to voluntary micturition and urinary incontinence in geriatric patients. Neurourol Urodyn 1993; 12: 1–7.Google Scholar
23Song, YF, Zhang, WJ, Song, J, Xu, B. Prevalence and risk factors of urinary incontinence in Fuzhou Chinese women. Chin Med J (Engl) 2005; 118: 887–92.Google ScholarPubMed
24Charach, G, Greenstein, A, Rabinovich, P, Groskopf, I, Weintraub, M. Alleviating constipation in the elderly improves lower urinary tract symptoms. Gerontology 2001; 47: 72–76.CrossRefGoogle ScholarPubMed
25Burgio, KL, Matthews, KA, Engel, BT. Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. J Urol 1991; 146: 1255–59.Google Scholar
26Koskimaki, J, Hakama, M, Huhtala, H, Tammela, TL. Association of smoking with lower urinary tract symptoms. J Urol 1998; 159: 1580–82.Google Scholar
27Morris, M. Maternity and post-operative exercises. London: William Heinemann Ltd; 1936.Google Scholar
28Kegel, AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol 1948; 56: 238–48.CrossRefGoogle ScholarPubMed
29Dumoulin, C, Hay-Smith, J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010; issue 1, art. no. CD005654.Google Scholar
30National Collaborating Centre for Women's and Children's Health. The management of urinary incontinence in women. NICE Clinical Guideline CG40. 2006.Google Scholar
31Hunter, KF, Moore, KN, Glazener, CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev 2007; issue 2, art. no. CD001843.Google Scholar
32Abrams, P, Cardozo, L, Fall, M, Griffiths, D, Rosier, P, Ulmsten, U, van Kerrebroeck, P, Victor, A, Wein, A. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 167–78.CrossRefGoogle ScholarPubMed
33Burgio, KL, Locher, JL, Goode, PS, Hardin, JM, McDowell, BJ, Dombrowski, M, Candib, D. Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA 1998; 280: 2034–35.CrossRefGoogle ScholarPubMed
34Burgio, KL, Goode, PS, Locher, JL, Umlauf, MG, Roth, DL, Richter, HE, Varner, RE, Lloyd, LK. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA 2002; 288: 2293–99.CrossRefGoogle ScholarPubMed
35Burns, PA, Pranikoff, K, Nochajski, TH, Hadley, EC, Levy, KJ, Ory, MG. A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women. J Gerontol 1993; 48: M167–74.Google ScholarPubMed
36Berghmans, LC, Hendriks, HJ, Bo, K, Hay-Smith, EJ, de Bie, RA, van Waalwijk van Doorn, ES. Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. Br J Urol 1998; 82: 181–91.Google Scholar
37Barroso, JC, Ramos, JG, Martins-Costa, S, Sanches, PR, Muller, AF. Transvaginal electrical stimulation in the treatment of urinary incontinence. BJU Int 2004; 93: 319–23.Google Scholar
38Jeyaseelan, SM, Haslam, EJ, Winstanley, J, Roe, BH, Oldham, JA. An evaluation of a new pattern of electrical stimulation as a treatment for urinary stress incontinence: a randomized, double-blind, controlled trial. Clin Rehabil 2000; 14: 631–40.Google Scholar
39Sand, PK, Richardson, DA, Staskin, DR, Swift, SE, Appell, RA, Whitmore, KE, Ostergard, DR. Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: a multicenter, placebo-controlled trial. Am J Obstet Gynecol 1995; 173: 72–79.Google Scholar
40Yamanishi, T, Yasuda, K, Sakakibara, R, Hattori, T, Suda, S. Randomized, double-blind study of electrical stimulation for urinary incontinence due to detrusor overactivity. Urology 2000; 55: 353–57.Google Scholar
41Bo, K, Talseth, T, Holme, I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 1999; 318: 487–93.Google Scholar
42Wang, AC, Wang, YY, Chen, MC. Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder. Urology 2004; 63: 61–66.CrossRefGoogle ScholarPubMed
43Lo, SK, Naidu, J, Cao, Y. Additive effect of interferential therapy over pelvic floor exercise alone in the treatment of female urinary stress and urge incontinence: a randomized controlled trial. Hong Kong Physiother J 2003; 21: 37–42.CrossRefGoogle Scholar
44Quek, P. A critical review on magnetic stimulation: what is its role in the management of pelvic floor disorders? Curr Opin Urol 2005; 15: 231–35.CrossRefGoogle ScholarPubMed
45But, I. Conservative treatment of female urinary incontinence with functional magnetic stimulation. Urology 2003; 61: 558–61.CrossRefGoogle ScholarPubMed
46But, I, Faganelj, M, Sostaric, A. Functional magnetic stimulation for mixed urinary incontinence. J Urol 2005; 173: 1644–46.CrossRefGoogle ScholarPubMed
47Wallace, SA, Roe, B, Williams, K, Palmer, M. Bladder training for urinary incontinence in adults. Cochrane Database Syst Rev 2004; issue 1, art. no. CD001308.CrossRefGoogle Scholar
48Roe, B, Ostaszkiewicz, J, Milne, J, Wallace, S. Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings from data analysis and outcomes using metastudy techniques. J Adv Nurs 2007; 57: 15–31.CrossRefGoogle ScholarPubMed
49Ostaszkiewicz, J, Johnston, L, Roe, B. Timed voiding for the management of urinary incontinence in adults. Cochrane Database Syst Rev 2004; issue 1, art. no. CD002802.Google Scholar
50Ostaszkiewicz, J, Roe, B, Johnston, L. Effects of timed voiding for the management of urinary incontinence in adults: systematic review. J Adv Nurs 2005; 52: 420–31.Google Scholar
51Ostaszkiewicz, J, Chestney, T, Roe, B. Habit retraining for the management of urinary incontinence in adults. Cochrane Database Syst Rev 2010; issue 2, art. no. CD 002801.Google Scholar
52Nikoletti, S, Young, J, King, M. Evaluation of an electronic monitoring device for urinary incontinence in elderly patients in an acute care setting. J Wound Ostomy Continence Nurs 2004; 31: 138–49.Google Scholar
53Durrant, J, Snape, J. Urinary incontinence in nursing homes for older people. Age Ageing 2003; 32: 12–18.CrossRefGoogle ScholarPubMed
54Schnelle, JF. Treatment of urinary incontinence in nursing home patients by prompted voiding. J Am Geriatr Soc 1990; 38: 356–60.Google Scholar
55Ouslander, JG, Schnelle, JF, Uman, G, Fingold, S, Nigam, JG, Tuico, E, Bates-Jensen, B. Predictors of successful prompted voiding among incontinent nursing home residents. JAMA 1995; 273: 1366–70.Google Scholar
56Eustice, S, Roe, B, Paterson, J. Prompted voiding for the management of urinary incontinence in adults. Cochrane Database Syst Rev 2000; issue 2, art. no. CD002113.CrossRefGoogle Scholar
57Pomfret, I, Vickerman, J, Tonge, P. Introducing a hand-held urinal service in secondary care. Nurs Times 2005; 101: 68.Google Scholar
58Vickerman, J. The benefits of a lending library for female urinals. Nurs Times 2003; 99: 56–57.Google Scholar
59Fader, M, Pettersson, L, Dean, G, Brooks, R, Cottenden, A. The selection of female urinals: results of a multicentre evaluation. Br J Nurs 1999; 8: 918–20, 922–25.Google Scholar
60Vickerman, J. Selecting urinals for male patients. Nurs Times 2006; 102: 47–48.Google Scholar
61Macaulay, M, Clarke-O'Neill, S, Cottenden, A, Fader, M, Van Den Heuvel, E, Jowitt, F. Female urinals for women with impaired mobility. Nurs Times 2006; 102: 42–3, 45, 47.Google Scholar
62Colley, W. Products to help men manage incontinence. Nurs Times 2002; 98: 52–54.Google ScholarPubMed