Behavioral therapy more effective than drugs for urinary incontinence

Most nonpharmacologic and pharmacologic interventions are more likely than no treatment to improve outcomes for women with either stress or urgency urinary incontinence (UI). Behavioural therapy, alone or in combination with other interventions, was found to be generally more effective than pharmacologic therapies alone. Findings from a systematic evidence review and network meta-analysis of clinical outcomes of nonpharmacologic and pharmacologic interventions for UI are published in Annals of Internal Medicine.

UI is a common malady in women and may be categorized as stress UI (the involuntary loss of urine with effort or physical exertion or on sneezing or coughing), urgency UI (a sudden compulsion to urinate that is difficult to defer), or mixed UI (with features of both stress and urgency UI). Nonsurgical interventions include nonpharmacologic interventions that aim to strengthen the pelvic floor or change behaviors that influence bladder function and pharmacologic treatments that primarily address bladder and urethral sphincter function.

Researchers from Brown University School of Public Health conducted a systematic review of the clinical effects of all nonsurgical treatments for stress, urgency, and mixed UI in nonpregnant women to compare their effectiveness for improving UI outcomes. A network meta-analysis included 84 studies and showed that all interventions studied, except hormones and periurethral bulking agents, resulted in better UI outcomes than no treatment. For stress UI, among treatments commonly used as first- or second-line interventions, behavioural therapy was more effective than either alpha agonists or hormones and combination behavioural therapy and hormones were more effective than alpha agonists. Alpha agonists were found to be more effective than hormones. There was 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, behavioural therapy was more effective than anticholinergics. Onabotulinum toxin A may be more effective than neuromodulation as third-line therapy.