Effective Interventions Available to Treat Urinary Incontinence in Women

Effective Interventions Available to Treat Urinary Incontinence in Women

A new AHRQ evidence review conducted in partnership with the Patient-Centered Outcomes Research Institute found that behavioral therapy is better than medication for treating stress and urge urinary incontinence (UI). Both treatment approaches are better than not treating the problem. The review found evidence to support a range of treatments, including behavioral therapies and behavioral therapy in combination with hormones (for stress UI) and alpha agonists (for stress UI) and anticholinergics (for urgency UI). There was insufficient evidence to comparative effectiveness of the periurethral bulking agents and intravesical pressure release as third-line treatments for women with stress UI.  Onabotulinum toxin A may be more effective than neuromodulation as third-line therapy for women with urgency UI. The report found that serious adverse effects are rare with the pharmacologic interventions but commons side effects include dry mouth, nausea, insomnia, and fatigue. Periurethral bulking agents are associated with erosion in a small percentage of women. Onabotulinum toxin A is associated with risk of urinary tract infections and urinary retention. 

Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update | Effective Health Care Program

Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

SYSTEMATIC REVIEW

August 8, 2018

This report is available in PDF only (Full Report [8.1 MB]). People using assistive technology may not be able to fully access information in this file. For additional assistance, please contact us.

Purpose of Review

Compare nonpharmacological and pharmacological interventions in adult women with urinary incontinence.

Key Messages

• The nonpharmacological and pharmacological interventions studied, except hormones and periurethral bulking agents, result in better urinary incontinence (UI) outcomes than no treatment.
• For stress UI, among treatments commonly used as first- or second-line interventions, behavioral therapy is more effective than either alpha agonists or hormones. Combination behavioral therapy and hormones are more effective than alpha agonists. Alpha agonists, in turn, are more effective than hormones.
• There is insufficient evidence comparing periurethral bulking agents and intravesical pressure release, treatments used as third-line interventions for women with stress UI.
• For urgency UI, among treatments commonly used as first- or second-line interventions, behavioral therapy is more effective than anticholinergics.
• Onabotulinum toxin A may be more effective than neuromodulation as third-line therapy for women with urgency UI.
• Dry mouth is the most common side effect of pharmacological interventions, particularly with anticholinergics. Duloxetine is associated with numerous constitutional adverse effects such as nausea, insomnia, and fatigue.
• Serious adverse events are rare for all interventions. Onabotulinum toxin A is associated with risk of urinary tract infections and urinary retention.  Periurethral bulking agents are associated with erosion in a small percentage of women.