A report from the U.S. Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ), reveals that adult women who suffer from urinary incontinence can benefit by performing pelvic floor muscle training exercises that have no adverse effects. The report also found that although medication treatments can be effective, their benefits are low and adverse effects are common.
The report, published in Annals of Internal Medicine, is a comparative effectiveness review prepared for AHRQ's Effective Health Care Program by the Minnesota Evidence-based Practice Center.
Carolyn M. Clancy, M.D., AHRQ Director, explained:
"Urinary incontinence can affect women in a variety of ways, including physically, psychologically and socially - and some of these impacts can be severe. This new report will help women and their clinicians work together to find the best treatment option based on each patient's individual circumstances."
Approximately 25% of young women, up to 57% of middle-aged and postmenopausal women, and around 75% of older women in nursing homes suffer from urinary incontinence. Urinary incontinence can inflict considerable and potentially debilitating lifestyle restrictions. In 2004, the United States spent around $19.5 billion on incontinence care. In addition, one estimate reveals that the annualized cost of women's nursing home admissions due to urinary incontinence was $3 billion and 6% of nursing home admissions of older women were due to urinary incontinence.
In this study, the team focused on stress incontinence and urgency incontinence. Stress incontinence is the inability to retain urine during sneezing or coughing and urgency incontinence is a sudden compelling urge to urinate that results in involuntary loss of urine.
According to the researchers, both stress and urgency incontinence usually occur when the urinary sphincter fails, often due to weak pelvic floor muscles. Pelvic floor muscles support the bladder, uterus and other pelvic organs.
The researchers found that exercises designed to increase the strength of the pelvic floor muscles (similar to Kegel exercises) were effective in a women's ability to hold their urine. These exercises, in addition to bladder training, improved both stress and urgency incontinence.
Although the report found that estrogen treatment was effective in treating stress incontinence, it also had some adverse effects. Furthermore, another medication called duloxetine (antidepressant) was found to be ineffective and had a high risk of adverse effects.
According to the report, the drugs reviewed were comparable in effectiveness, although more women discontinued treatment with some drugs as a result of adverse effects. The report will help patients and clinicians select the best treatment options with the most benefits and least harms, via its comprehensive information regarding each medications adverse effects.
Even though there is significant evidence on clinical measures for treatment of the condition, such as grams of urine lost, there are less measures of quality of life associated to urinary incontinence and its treatments.
The report, Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness, is the latest comparative effectiveness review from AHRQ's Effective Health Care Program.
Written By Grace Rattue