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. 2003 May;49:602–610.

Urinary incontinence. Non-surgical management by family physicians.

K N Moore 1, B Saltmarche 1, A Query 1
PMCID: PMC2214231  PMID: 12790272

Abstract

OBJECTIVE: To review current evidence on conservative management of urinary incontinence (UI) by family physicians. QUALITY OF EVIDENCE: Articles were sought through MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CINAHL, PsycLit, ERIC, two consensus meetings, and review of abstracts presented at urology meetings. References of these articles were searched for relevant trials. Strong evidence supports bladder training, pelvic floor exercises, and some medications, but only fair evidence supports fluid adjustment, caffeine reduction, and stopping smoking. Weight loss and exercise are supported by expert opinion only. Consensus opinion is that, whenever possible, conservative management should be considered first. MAIN MESSAGE: Good evidence shows that initial management by primary care physicians is effective. After basic assessment and tests, strategies such as bladder retraining, pelvic floor exercises, and lifestyle modifications, augmented by appropriate medications, can be successful. If initial strategies are unsuccessful, patients can be referred. CONCLUSION: More than a million Canadians suffer from UI. In almost all cases, family physicians are the first health professionals contacted by patients. Basic assessment and conservative management can go far to ameliorate the problem.

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Selected References

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  1. Blaivas J. G. The bladder is an unreliable witness. Neurourol Urodyn. 1996;15(5):443–445. doi: 10.1002/(SICI)1520-6777(1996)15:5<443::AID-NAU1>3.0.CO;2-F. [DOI] [PubMed] [Google Scholar]
  2. Borrie Michael J., Valiquette Luc. Managing adults with urinary incontinence. Clinical practice guidelines. Can Fam Physician. 2002 Jan;48:114–116. [PMC free article] [PubMed] [Google Scholar]
  3. Brown J. S., Seeley D. G., Fong J., Black D. M., Ensrud K. E., Grady D. Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group. Obstet Gynecol. 1996 May;87(5 Pt 1):715–721. doi: 10.1016/0029-7844(96)00013-0. [DOI] [PubMed] [Google Scholar]
  4. Bump R. C., McClish D. K. Cigarette smoking and urinary incontinence in women. Am J Obstet Gynecol. 1992 Nov;167(5):1213–1218. doi: 10.1016/s0002-9378(11)91691-3. [DOI] [PubMed] [Google Scholar]
  5. Bump R. C., McClish D. M. Cigarette smoking and pure genuine stress incontinence of urine: a comparison of risk factors and determinants between smokers and nonsmokers. Am J Obstet Gynecol. 1994 Feb;170(2):579–582. doi: 10.1016/s0002-9378(94)70231-4. [DOI] [PubMed] [Google Scholar]
  6. Bump R. C., Sugerman H. J., Fantl J. A., McClish D. K. Obesity and lower urinary tract function in women: effect of surgically induced weight loss. Am J Obstet Gynecol. 1992 Aug;167(2):392–399. doi: 10.1016/s0002-9378(11)91418-5. [DOI] [PubMed] [Google Scholar]
  7. Burgio K. L., Matthews K. A., Engel B. T. Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. J Urol. 1991 Nov;146(5):1255–1259. doi: 10.1016/s0022-5347(17)38063-1. [DOI] [PubMed] [Google Scholar]
  8. Bø 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 Feb 20;318(7182):487–493. doi: 10.1136/bmj.318.7182.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bø K., Talseth T. Long-term effect of pelvic floor muscle exercise 5 years after cessation of organized training. Obstet Gynecol. 1996 Feb;87(2):261–265. doi: 10.1016/0029-7844(95)60375-1. [DOI] [PubMed] [Google Scholar]
  10. Bø K. Vaginal weight cones. Theoretical framework, effect on pelvic floor muscle strength and female stress urinary incontinence. Acta Obstet Gynecol Scand. 1995 Feb;74(2):87–92. doi: 10.3109/00016349509008913. [DOI] [PubMed] [Google Scholar]
  11. Chiverton P. A., Wells T. J., Brink C. A., Mayer R. Psychological factors associated with urinary incontinence. Clin Nurse Spec. 1996 Sep;10(5):229–233. doi: 10.1097/00002800-199609000-00007. [DOI] [PubMed] [Google Scholar]
  12. Creighton S. M., Stanton S. L. Caffeine: does it affect your bladder? Br J Urol. 1990 Dec;66(6):613–614. doi: 10.1111/j.1464-410x.1990.tb07192.x. [DOI] [PubMed] [Google Scholar]
  13. Ding Y. Y., Lieu P. K., Choo P. W. Is the bladder "an unreliable witness" in elderly males with persistent lower urinary tract symptoms? Geriatr Nephrol Urol. 1997;7(1):17–21. doi: 10.1023/a:1008299528728. [DOI] [PubMed] [Google Scholar]
  14. Diokno A. C., Brock B. M., Herzog A. R., Bromberg J. Medical correlates of urinary incontinence in the elderly. Urology. 1990 Aug;36(2):129–138. doi: 10.1016/0090-4295(90)80211-5. [DOI] [PubMed] [Google Scholar]
  15. Dowd T. T., Campbell J. M., Jones J. A. Fluid intake and urinary incontinence in older community-dwelling women. J Community Health Nurs. 1996;13(3):179–186. doi: 10.1207/s15327655jchn1303_5. [DOI] [PubMed] [Google Scholar]
  16. Dwyer P. L., Lee E. T., Hay D. M. Obesity and urinary incontinence in women. Br J Obstet Gynaecol. 1988 Jan;95(1):91–96. doi: 10.1111/j.1471-0528.1988.tb06486.x. [DOI] [PubMed] [Google Scholar]
  17. Fink D., Perucchini D., Schaer G. N., Haller U. The role of the frequency-volume chart in the differential diagnostic of female urinary incontinence. Acta Obstet Gynecol Scand. 1999 Mar;78(3):254–257. [PubMed] [Google Scholar]
  18. Fried G. W., Goetz G., Potts-Nulty S., Cioschi H. M., Staas W. E., Jr A behavioral approach to the treatment of urinary incontinence in a disabled population. Arch Phys Med Rehabil. 1995 Dec;76(12):1120–1124. doi: 10.1016/s0003-9993(95)80119-7. [DOI] [PubMed] [Google Scholar]
  19. Griffiths D. J., McCracken P. N., Harrison G. M., Gormley E. A. Relationship of fluid intake to voluntary micturition and urinary incontinence in geriatric patients. Neurourol Urodyn. 1993;12(1):1–7. doi: 10.1002/nau.1930120102. [DOI] [PubMed] [Google Scholar]
  20. Grimby A., Milsom I., Molander U., Wiklund I., Ekelund P. The influence of urinary incontinence on the quality of life of elderly women. Age Ageing. 1993 Mar;22(2):82–89. doi: 10.1093/ageing/22.2.82. [DOI] [PubMed] [Google Scholar]
  21. Harvey M. A., Baker K., Wells G. A. Tolterodine versus oxybutynin in the treatment of urge urinary incontinence: a meta-analysis. Am J Obstet Gynecol. 2001 Jul;185(1):56–61. doi: 10.1067/mob.2001.116371. [DOI] [PubMed] [Google Scholar]
  22. Herr H. W. Quality of life of incontinent men after radical prostatectomy. J Urol. 1994 Mar;151(3):652–654. doi: 10.1016/s0022-5347(17)35038-3. [DOI] [PubMed] [Google Scholar]
  23. Hunskaar S., Vinsnes A. The quality of life in women with urinary incontinence as measured by the sickness impact profile. J Am Geriatr Soc. 1991 Apr;39(4):378–382. doi: 10.1111/j.1532-5415.1991.tb02903.x. [DOI] [PubMed] [Google Scholar]
  24. Jackson S. L., Weber A. M., Hull T. L., Mitchinson A. R., Walters M. D. Fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 1997 Mar;89(3):423–427. doi: 10.1016/S0029-7844(96)00499-1. [DOI] [PubMed] [Google Scholar]
  25. Jønler M., Madsen F. A., Rhodes P. R., Sall M., Messing E. M., Bruskewitz R. C. A prospective study of quantification of urinary incontinence and quality of life in patients undergoing radical retropubic prostatectomy. Urology. 1996 Sep;48(3):433–440. doi: 10.1016/S0090-4295(96)00216-6. [DOI] [PubMed] [Google Scholar]
  26. Koskimäki J., Hakama M., Huhtala H., Tammela T. L. Association of smoking with lower urinary tract symptoms. J Urol. 1998 May;159(5):1580–1582. doi: 10.1097/00005392-199805000-00046. [DOI] [PubMed] [Google Scholar]
  27. Lagro-Janssen A. L., Debruyne F. M., Smits A. J., van Weel C. The effects of treatment of urinary incontinence in general practice. Fam Pract. 1992 Sep;9(3):284–289. doi: 10.1093/fampra/9.3.284. [DOI] [PubMed] [Google Scholar]
  28. Lagro-Janssen T., van Weel C. Long-term effect of treatment of female incontinence in general practice. Br J Gen Pract. 1998 Nov;48(436):1735–1738. [PMC free article] [PubMed] [Google Scholar]
  29. MacDonald A., Shearer M., Paterson P. J., Finlay I. G. Relationship between outlet obstruction constipation and obstructed urinary flow. Br J Surg. 1991 Jun;78(6):693–695. doi: 10.1002/bjs.1800780620. [DOI] [PubMed] [Google Scholar]
  30. Members of the Consensus Development Panel Consensus conference. Urinary incontinence in adults. JAMA. 1989 May 12;261(18):2685–2690. doi: 10.1001/jama.1989.03420180109040. [DOI] [PubMed] [Google Scholar]
  31. Menefee S. A., Chesson R., Wall L. L. Stress urinary incontinence due to prescription medications: alpha-blockers and angiotensin converting enzyme inhibitors. Obstet Gynecol. 1998 May;91(5 Pt 2):853–854. doi: 10.1016/s0029-7844(97)00497-3. [DOI] [PubMed] [Google Scholar]
  32. Miller J. M., Ashton-Miller J. A., DeLancey J. O. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998 Jul;46(7):870–874. doi: 10.1111/j.1532-5415.1998.tb02721.x. [DOI] [PubMed] [Google Scholar]
  33. Moore K. N., Estey A. The early post-operative concerns of men after radical prostatectomy. J Adv Nurs. 1999 May;29(5):1121–1129. doi: 10.1046/j.1365-2648.1999.00995.x. [DOI] [PubMed] [Google Scholar]
  34. O'Brien J. Evaluating primary care interventions for incontinence. Nurs Stand. 1996 Feb 28;10(23):40–43. [PubMed] [Google Scholar]
  35. Pannek J., Haupt G., Sommerfeld H. J., Schulze H., Senge T. Urodynamic and rectomanometric findings in urinary incontinence. Scand J Urol Nephrol. 1996 Dec;30(6):457–460. doi: 10.3109/00365599609182323. [DOI] [PubMed] [Google Scholar]
  36. Patterson C. J., Gauthier S., Bergman H., Cohen C. A., Feightner J. W., Feldman H., Hogan D. B. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. CMAJ. 1999 Jun 15;160(12 Suppl):S1–15. [PMC free article] [PubMed] [Google Scholar]
  37. Platz E. A., Kawachi I., Rimm E. B., Colditz G. A., Stampfer M. J., Willett W. C., Giovannucci E. Physical activity and benign prostatic hyperplasia. Arch Intern Med. 1998 Nov 23;158(21):2349–2356. doi: 10.1001/archinte.158.21.2349. [DOI] [PubMed] [Google Scholar]
  38. Robinson D., McClish D. K., Wyman J. F., Bump R. C., Fanti J. A. Comparison between urinary diaries completed with and without intensive patient instructions. Neurourol Urodyn. 1996;15(2):143–148. doi: 10.1002/(SICI)1520-6777(1996)15:2<143::AID-NAU3>3.0.CO;2-F. [DOI] [PubMed] [Google Scholar]
  39. Sampselle C. M., Wyman J. F., Thomas K. K., Newman D. K., Gray M., Dougherty M., Burns P. A. Continence for women: a test of AWHONN's evidence-based protocol in clinical practice. Association of Women's Health Obstetric and Neonatal Nurses. J Obstet Gynecol Neonatal Nurs. 2000 Jan-Feb;29(1):18–26. doi: 10.1111/j.1552-6909.2000.tb02752.x. [DOI] [PubMed] [Google Scholar]
  40. Sander Pia, Mouritsen L., Andersen J. Thorup, Fischer-Rasmussen W. Should measurement of maximum urinary flow rate and residual urine volume be a part of a "minimal care" assessment programme in female incontinence? Scand J Urol Nephrol. 2002;36(2):124–127. doi: 10.1080/003655902753679418. [DOI] [PubMed] [Google Scholar]
  41. Seim A., Hermstad R., Hunskaar S. Management in general practice significantly reduced psychosocial consequences of female urinary incontinence. Qual Life Res. 1997 Apr;6(3):257–264. doi: 10.1023/a:1026414822573. [DOI] [PubMed] [Google Scholar]
  42. Smith A. R., Hosker G. L., Warrell D. W. The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol. 1989 Jan;96(1):29–32. doi: 10.1111/j.1471-0528.1989.tb01572.x. [DOI] [PubMed] [Google Scholar]
  43. Szonyi G., Collas D. M., Ding Y. Y., Malone-Lee J. G. Oxybutynin with bladder retraining for detrusor instability in elderly people: a randomized controlled trial. Age Ageing. 1995 Jul;24(4):287–291. doi: 10.1093/ageing/24.4.287. [DOI] [PubMed] [Google Scholar]
  44. Tomlinson B. U., Dougherty M. C., Pendergast J. F., Boyington A. R., Coffman M. A., Pickens S. M. Dietary caffeine, fluid intake and urinary incontinence in older rural women. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(1):22–28. doi: 10.1007/pl00004009. [DOI] [PubMed] [Google Scholar]
  45. Wyman J. F., Fantl J. A. Bladder training in ambulatory care management of urinary incontinence. Urol Nurs. 1991 Sep;11(3):11–17. [PubMed] [Google Scholar]
  46. Wyman J. F., Fantl J. A., McClish D. K., Bump R. C. Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. Am J Obstet Gynecol. 1998 Oct;179(4):999–1007. doi: 10.1016/s0002-9378(98)70206-6. [DOI] [PubMed] [Google Scholar]

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