Surgery is the most reliable method of treatment for incontinence - curing the condition in just over eight in ten cases; other types of treatment, meanwhile, do not deliver the same kind of success. These are the findings of a comprehensive systematic overview of cure rates for the treatment of incontinence around the world during the last ten years.
"Unfortunately we are not actually curing the condition in that many cases. Surgery aside, the results delivered are poor. And the problems are only going to get worse in the future because the population, as we know, is aging," says Ian Milsom, Professor of Gynecology and Obstetrics at the Sahlgrenska Academy and Head of the Gothenburg Continence Research Center (GCRC).
He and a group of researcher colleagues have together studied thousands of research articles and other scientific documentation written about different treatments of urinary and fecal incontinence in adults around the world, published between 2005 and 2015.
The sheer scope of the research makes this work unique. The researchers sifted through the mass of material using harmonized criteria and ultimately came up with percentages indicating how well or poorly different methods had worked. For the results to be considered successful, the individual must have been cured of incontinence three months after the treatment.
Surgery by Far the Best
Surgery ranks well ahead of other methods, delivering success in 82 percent of cases. Pelvic floor exercises rank second, with 53 percent, followed by drug treatment, with 49 percent.
Bottom of the pile was treatment using so-called bulking agents, which was only successful in 37 percent of cases. This method involves injections of fillers into damaged tissue around the urethra in order to keep the area tight.
Drugs are mainly prescribed to treat urinary incontinence and calm down overactive bladders. Ian Milsom finds it remarkable, including from a financial perspective, that these antimuscarinic drugs are not even helping half of all patients.
"The results don't look good at all considering the cost in billions that these drugs incur on health care systems. In contrast surgery on the other hand has become simpler and more effective and is delivering strong results even in the long term," he says.
Research Limping Along
Relatively few studies over the ten-year period focused on the elderly, despite their susceptibility to the condition. The same goes for people with neurological conditions. There were also insufficient studies into how individuals can live normal lives with incontinence by modifying their behavior and using catheters and absorbent protection.
Urinary and fecal incontinence have an impact on well-being and quality of life and sometimes lead to people feeling isolated in life, both professionally and socially. They also have an adverse effect on sexual health and, as far as the elderly as a group are concerned, increase the risk of institutionalization.
"This is a major issue for humans that we need to devote more research resources to, not just in Sweden but around the world. Five hundred million people on this planet are suffering from the condition; we need to improve treatment methods, not least for the elderly and those with neurological conditions, who it hits particularly hard," says Ian Milsom.
Article: Can incontinence be cured? A systematic review of cure rates, Rob Riemsma, Suzanne Hagen, Ruth Kirschner-Hermanns, Christine Norton, Helle Wijk, Karl-Erik Andersson, Christopher Chapple, Julian Spinks, Adrian Wagg, Edward Hutt, Kate Misso, Sohan Deshpande, Jos Kleijnen and Ian Milsom, BMC Medicine, doi: 10.1186/s12916-017-0828-2, published 24 March 2017.