Kegel exercises to strengthen pelvic floor muscles, bladder training, and weight loss and exercise are effective nonsurgical treatment options for women with urinary incontinence (UI), according to a new evidence-based clinical practice guideline from the American College of Physicians (ACP) being published Annals of Internal Medicine. UI affects about 25 percent of women ages 14 to 21, 44 to 57 percent of women ages 40 to 60, and 75 percent of women ages 75 and older. These estimates may be low as one study showed that at least half of incontinent women do not report the issue to their physician.
ACP recommends that medications be avoided, if possible. Instead, women with stress UI (the inability to retain urine when laughing, coughing, or sneezing), should practice Kegel exercises, a form of pelvic floor muscle training that comprise relaxing and tightening the muscles that control urine flow. For women with urgency UI (the loss of urine for no apparent reason after suddenly feeling the need or urge to urinate), ACP recommends bladder training, a form of behavioral therapy that involves urinating on a set schedule and gradually increasing the time between urination. If bladder training is unsuccessful, ACP recommends that physicians choose a medication based on adverse effects and tolerability, ease of use, and cost. For women with mixed UI, a combination of stress and urgency incontinence, ACP recommends Kegel exercises with bladder training. For obese women with UI, ACP recommends weight loss and exercise.
Article: Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline From the American College of Physicians, A. Qaseem, P. Dallas, M.A. Forciea, M. Starkey, T.D. Denberg, and P. Shekelle, Annals of Internal Medicine, published 15 September 2014.