Few effective options for urinary incontinence

A few nonsurgical treatments for urinary incontinence in women provide modest improvement at best, and expensive drug therapies are really no more effective than pelvic floor muscle and bladder training, say the findings of a systematic review of 96 randomized controlled trials and three systematic reviews published in English from 1990 to 2007.

The only treatments that really seem to make any difference are pelvic floor muscle training plus bladder training, which, compared with regular care, had a pooled risk difference of 0.13 (95% CI, 0.07 to 0.20), and oxybutynin or tolterodine, which had a pooled risk difference compared with placebo of 0.18 (95% CI, 0.13–0.22). Pelvic floor muscle training alone provided relief or resolution, but did so inconsistently across studies, as did transdermal or vaginal estrogen. Compared with placebo, duloxetine provided improvement (pooled risk difference 0.11; 95% CI, 0.07–0.14), but did not resolve urinary incontinence. Electrical stimulation and adrenergic drugs failed to provide any improvement, and oral hormones actually made urinary incontinence worse.

Shamliyan TA, Kane RL, Wyman J, et al. Systematic review: randomized, controlled trials of nonsurgical treatment for urinary incontinence in women. Ann Intern Med. 2008;148:459-473.