Both behavioral and drug treatments can be effective in treating women for urinary incontinence, researchers report in the Annals of Internal Medicine, and they may work even better in combination.
Researchers analyzed data from 84 randomized trials that looked at a variety of treatments for stress and urgency incontinence. Nondrug treatments, usually aimed at strengthening the pelvic floor or changing behaviors, included bladder training, biofeedback, acupuncture, education, weight loss, yoga and other treatments. Pharmacological treatments included hormones, antiepileptic medications, drugs or procedures that affect the nervous system, and botulinum toxin, among others.
Over all, they found good evidence that all approaches except hormone treatment and injection of bulking agents were better than no treatment at all at achieving improvement or cure. Behavioral therapies, alone or in combination with drugs, were generally more effective than any single drug. Drug treatments were sometimes associated with unpleasant, although not serious, side effects.
“A reasonable approach is to start with behavioral modifications,” said the senior author, Dr. Peter C. Jeppson, an assistant professor of urogynecology at the University of New Mexico. “If that’s unsuccessful, then move on to medications or procedures. But this is a quality-of-life issue, not a life-threatening problem, and I would go through all the options and let the patient decide.”
