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Non-surgical approaches to managing female urinary incontinence – what works?

Kathryn Waldegrave writes about a study investigating non-surgical treatments for urinary incontinence. 

Female urinary incontinence (UI) is a prevalent condition worldwide, experienced by many women across all communities and care settings. Increasing with age, especially following the menopause, the most common types of UI in non-pregnant women are stress, urgency and mixed incontinence. The unpredictable nature of UI may lead to significant negative effects on physical, psychological and social well-being, substantially limiting and restricting daily life. Approaches to managing UI encompass a variety of both non-pharmacological and pharmacological interventions. Non-pharmacological approaches aim to educate women about the importance of strengthening the pelvic floor, or utilise behaviour change to influence the bladder function. Pharmacological therapies have the sole purpose of treating both bladder and urethral sphincter function.

To compare the effectiveness of both pharmacological and non-pharmacological interventions in improving or curing UI, a recent study conducted a systematic review and network meta-analysis of non-surgical treatments. Searching a variety of sources produced 84 eligible studies, initially categorised into interventions, and then sub-divided on the basis of whether the primary recommendation made was for stress or urgency UI. Behavioural therapy appeared in both categories. Interventions were then stratified into groups defining the level of treatment.

The main conclusion drawn from the study highlights that most pharmacological and non-pharmacological interventions are more likely than no treatment to improve UI outcomes. Behavioural interventions to manage UI, alone or delivered in conjunction with other treatments, are generally more effective than pharmacological therapies.

A commentary acknowledges the complexity of managing UI, however, highlights the positive role of nursing in implementing and supporting behaviour interventions for patients. The commentary recognises that nurses may need to take action to improve their own knowledge and practice in managing UI and advocates for increased education in order to stay current with the most appropriate pharmacological treatments. Alongside this, further research exploring the barriers to implementing behaviour change should be considered, in order that these can be eliminated. UI is often a misunderstood, taboo subject but one which can be treated effectively with a combination of non-surgical interventions and support from healthcare professionals.

 

  • Study reference: Zhang, N. ‘Behavioural and pharmacological interventions are more effective than no treatment for urinary incontinence outcomes in women’. Evid Based Nurs. Published Online First: 11 July 2019, doi: 10.1136/ebnurs-2019-103126
  • Commentary reference: Balk, EM; Rofeberg, VN; Adam, GP, et al. ‘Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes’. Ann Intern Med, March 2019; doi: 10.7326/M18-3227

Kathryn Waldegrave is a lecturer in community nursing at the University of Leeds

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