Clinical Inquiries

How can we effectively treat stress urinary incontinence without drugs or surgery?

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References

EVIDENCE-BASED ANSWER:

Pelvic floor muscle training (PFMT) and intravaginal electrical stimulation seem to be the best bets. PFMT increases urinary continence and improves symptoms of stress urinary incontinence (SUI) (strength of recommendation [SOR]: A, systematic review or randomized, controlled trials [RCTs]). PFMT also improves quality of life (QOL) (activity and psychological impact) (SOR: B, 1 RCT).

Intravaginal electrical stimulation increases urinary continence and improves SUI symptoms; percutaneous electrical stimulation also improves SUI symptoms and likely improves QOL measures (SOR: A, systematic review).

Magnetic stimulation doesn’t increase continence, has mixed effects on SUI symptoms, and produces no clinically meaningful improvement in QOL (SOR: B, heterogeneous RCTs with conflicting results). Vaginal cones don’t increase continence or QOL (SOR: B, 2 RCTs with methodologic flaws).

EVIDENCE SUMMARY

A systematic review by the Agency for Healthcare Research and Quality of adult female outpatients with SUI examined the effectiveness of PFMT, electrical stimulation, magnetic stimulation, and vaginal cones compared with no active treatment or sham treatment to produce continence (90% to 100% symptom reduction) or improve symptoms (at least 50% patient-reported symptom reduction).1 The TABLE summarizes the results.1 Investigators also assessed improvement in patient-reported QOL.

Pelvic floor muscle training improves continence, quality of life

A meta-analysis of 10 RCTs demonstrated that PFMT produced continence more often than placebo, and a meta-analysis of 6 RCTs found that PFMT improved SUI symptoms.1 PFMT regimens ranged in duration from 8 weeks to 6 months, including unsupervised treatment (8 to 12 repetitions, 3 to 10 times a day) and supervised treatment (as long as an hour, as often as 3 times a week).1

Both unsupervised and supervised PFMT produced similar results. One RCT evaluating QOL measures found that PFMT improved activity and reduced psychological impact (number needed to treat [NNT]=1; 95% confidence interval [CI], 1-2).1

Evidence-based answers from the Family Physicians Inquiries Network

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