Cochrane Corner

In September 2022, an overview of Cochrane reviews on conservative interventions for treating urinary incontinence in women was published by Todhnuter-Brown et al. 29 relevant Cochrane reviews that included women aged 18 years or older with a clinical diagnosis of stress urinary incontinence (SUI), urgency urinary incontinence (UUI), or mixed urinary incontinence (MUI), and investigating a conservative intervention aimed at improving or curing UI, were included in the summary.

The included reviews focused on physical therapies (7), education (5), behavioral and lifestyle advice (1), mechanical devices (1), acupuncture (1) and yoga (1). Fourteen reviews compared non-conservative interventions with conservative interventions. No reviews synthesized evidence relating to psychological therapies. There were 112 unique trials (including 8975 women) that had primary outcome data included in at least one analysis.

The following were the summarized results:

Stress Urinary Incontinence (14 reviews)

Conservative Intervention versus Control

• There was moderate or high certainty evidence that pelvic floor muscle training (PFMT), PFMT plus biofeedback and cones were more beneficial than control for curing or improving UI.
• PFMT and intravaginal devices improved quality of life compared to control.

One Conservative Intervention versus Another Conservative Intervention

For cure and improvement of UI, there was moderate or high certainty evidence that:

• Continence pessary plus PFMT was more beneficial than continence pessary alone.
• PFMT plus educational intervention was more beneficial than cones.
• More‐intensive PFMT was more beneficial than less‐intensive PFMT.
• PFMT plus an adherence strategy was more beneficial than PFMT alone.

There was no moderate or high certainty evidence for quality of life.

Urgency Urinary Incontinence (5 reviews)

Conservative Intervention versus Control

There was moderate to high‐certainty evidence demonstrating that:

• PFMT plus feedback, PFMT plus biofeedback, electrical stimulation and bladder training were more beneficial than control for curing or improving UI.
• Women using electrical stimulation plus PFMT had higher quality of life than women in the control group.

One Conservative Intervention versus Another Conservative Intervention

For cure or improvement:

• There was moderate certainty evidence that electrical stimulation was more effective than laseropuncture.
• There was high or moderate certainty evidence that PFMT resulted in higher quality of life than electrical stimulation and electrical stimulation plus PFMT resulted in better cure or improvement and higher quality of life than PFMT alone.

All types of Urinary Incontinence (13 reviews)

Conservative Intervention versus Control

• There was moderate to high certainty evidence of better cure or improvement with PFMT, electrical stimulation, weight loss and cones compared to control.
• There was moderate certainty evidence of improved quality of life with PFMT compared to control.

One Conservative Intervention versus Another Conservative Intervention

• There was moderate or high certainty evidence of better cure or improvement for PFMT with bladder training than bladder training alone.
• PFMT with more individual health professional supervision was more effective than less contact/supervision and more‐intensive PFMT was more beneficial than less‐intensive PFMT.
• There was moderate certainty evidence that PFMT plus bladder training resulted in higher quality of life than bladder training alone.

Conclusion

There is high certainty that:

• PFMT is more beneficial than control for all types of UI for outcomes of cure or improvement and quality of life.
• For cure or improvement, cones are more beneficial than control (but not PFMT) for women with SUI, electrical stimulation is beneficial for women with UUI, and weight loss is more beneficial than control for all types of urinary incontinence.
• There is moderate certainty that if PFMT is more intense, more frequent, with individual supervision, with/without combined with behavioral interventions with/without an adherence strategy, effectiveness is improved.

REFERENCE

Todhunter-Brown A, Hazelton C, Campbell P, Elders A, Hagen S, McClurg D. Conservative interventions for treating urinary incontinence in women: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews. September 2022. https://doi.org/10.1002/14651858.CD012337.pub2.