General

Clinical Question:
What treatments are effective for urinary incontinence in women?

Bottom Line:
The anticholinergic drugs oxybutynin (Ditropan) and tolterodine (Detrol) have the best evidence regarding the improvement of incontinence in women. In a single head-to-head study of extended-release products, tolterodine was slightly more effective than oxybutynin, but the results are imprecise. Pelvic floor muscle exercises with bladder training can resolve incontinence in many women. Transurethral injection of bulking agents produces variable results. Duloxetine (Cymbalta) reduces but does not cure incontinence. Oral estrogen therapy consistently worsens symptoms, and electrical stimulation is ineffective. (LOE = 1a)

Reference:
Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: Randomized controlled trials of nonsurgical treatments of urinary incontinence in women. Ann Intern Med 2008;148:459-573.  [PMID:18268288]

Study Design:
Systematic review

Setting:
Various (meta-analysis)

Synopsis:
To evaluate therapies, the authors search for English-language randomized trials in 3 databases, including the Cochrane databases. They also searched reference lists and proceedings from an international conference, and contacted experts. Two researchers independently abstracted the data. They used the researchers' own definition of urinary continence rather than settling on a specific definition. As a result, we don't have a clear end point to compare across interventions. Pelvic floor muscle training produced variable benefits in clinical trials, but in combination with bladder training the results were more consistent across studies. Research of bulking agents injected into the urethra or around the urethra produced variable effects and only one study showed a significant benefit using autologous myoblasts and fibroblasts. Oral hormone therapy consistently worsens incontinence, and transdermal or vaginal administration resulted in inconsistent results except in women with mild incontinence. Electrical stimulation is ineffective. The anticholinergic drugs oxybutynin and tolterodine resolve more episodes than placebo. Duloxetine improves but does not resolve incontinence.