Exercises trump drugs for managing incontinence

Pelvic floor muscle training is safer and significantly more effective than medication for managing both stress and urgency urinary incontinence.

Regardless of the therapeutic approach, patient compliance is critical to long-term success.

Overall, drugs for urinary incontinence (UI) have relatively little benefit, side effects keep compliance low, and long-term safety is still questionable, but pelvic floor muscle training (PFMT) can make a world of difference if women will stick with it, according to a Comparative Effectiveness Review conducted by the Effective Health Care Program arm of the Agency for Healthcare Research and Quality (AHRQ).

The analysis of 905 studies found that nonpharmacologic treatment-PFMT-can result in significant benefit, making up to 100% difference in continence rates, with no adverse effects. Similar rates of success were reported, regardless of whether patients used biofeedback with the exercises.

By comparison, the report notes that antimuscarinics are more effective than placebo, but the degree of benefit was low for all drugs, with fewer than 200 cases of continence attributable to treatment per 1,000 women. Dry mouth, constipation, and blurred vision were cited as the side effects chiefly responsible for low compliance with prescription drugs.

Women with daily stress UI perceive clinical benefit from a treatment when frequency is reduced approximately 50%, but they typically only report improved quality of life and clinical success when they experience at least a 70% reduction in frequency. Similarly, more than 60% of women with persistent urgency, stress, or mixed UI report complete treatment satisfaction when they experience more than 70% reduction of UI episodes.

The review reports that available diagnostic tests are of minimal value in distinguishing women with stress or urgency UI. Although nonsurgical treatment decisions are driven by clinical evaluation with validated tools for diagnosis of UI, multichannel urodynamics was no more accurate than patients’ self-reports of symptoms at predicting who would benefit from nonsurgical options.

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