Non-operative methods for the treatment of female stress urinary incontinence
DOI:
https://doi.org/10.12775/QS.2024.17.53058Keywords
stress urinary incontinence, pelvic floor muscle training, physical activity, vaginal oestrogens, duloxetineAbstract
Purpose of research: Stress urinary incontinence (SUI) is a common health problem, especially among women which impairs daily functioning. The purpose of this research is to elucidate the pathophysiology of stress urinary incontinence (SUI), describe its diagnostic methods, summarize current treatments in light of recent studies, and outline examples of new potential therapies.
Methods: Databases such as PubMed, Medline, and ResearchGate were searched with particular attention to the current guidelines.
Basic results: The primary treatment of SUI is lifestyle modification, including weight reduction. Pelvic floor muscle training (PFMT) is recommended as first-line therapy, reducing the number of incontinence episodes and improving quality of life. Additional methods include electrical stimulation or biofeedback. At later stages of treatment, pharmacological therapy is recommended, mainly using vaginal oestrogens and duloxetine.
Conclusions: Non-operative therapies, such as lifestyle modification and PFMT, are effective treatments for SUI. In combination with pharmacotherapy, they significantly improve the quality of life of patients without invasive surgical procedures.
References
Alasmi RA, Saqyan TMB, Alanazi LF, Alharbi MF, Alashgae AF. Urinary incontinence: Comparison study to identify the type, incidence and risk factors between admitted women and the general population in Al-Kharj city, Saudi Arabia. Urol Ann. 2023 Jan-Mar;15(1):68-73. doi: 10.4103/ua.ua_188_21. Epub 2022 Sep 16. PMID: 37006218; PMCID: PMC10062512.
Kopańska M, Torices S, Czech J, Koziara W, Toborek M, Dobrek Ł. Urinary incontinence in women: biofeedback as an innovative treatment method. Ther Adv Urol. 2020 Jun 25;12:1756287220934359. doi: 10.1177/1756287220934359. PMID: 32647538; PMCID: PMC7325537.
Sun H, Huang J, Tang H, Wei B. Association between weight-adjusted-waist index and urge urinary incontinence: a cross-sectional study from NHANES 2013 to 2018. Sci Rep. 2024 Jan 4;14(1):478. doi: 10.1038/s41598-024-51216-2. PMID: 38177657; PMCID: PMC10767076.
Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6 Suppl 3(Suppl 3):S3-9. PMID: 16985863; PMCID: PMC1472862.
Yang X, Wang X, Gao Z, Li L, Lin H, Wang H, Zhou H, Tian D, Zhang Q, Shen J. The Anatomical Pathogenesis of Stress Urinary Incontinence in Women. Medicina (Kaunas). 2022 Dec 20;59(1):5. doi: 10.3390/medicina59010005. PMID: 36676629; PMCID: PMC9865065.
Khandelwal C, Kistler C. Diagnosis of urinary incontinence. Am Fam Physician. 2013 Apr 15;87(8):543-50. PMID: 23668444.
Harland N, Walz S, Eberli D, Schmid FA, Aicher WK, Stenzl A, Amend B. Stress Urinary Incontinence: An Unsolved Clinical Challenge. Biomedicines. 2023 Sep 7;11(9):2486. doi: 10.3390/biomedicines11092486. PMID: 37760927; PMCID: PMC10525672.
Drake MJ, Doumouchtsis SK, Hashim H, Gammie A. Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations. Neurourol Urodyn. 2018 Aug;37(S6):S50-S60. doi: 10.1002/nau.23773. PMID: 30614058.
Clement KD, Burden H, Warren K, Lapitan MC, Omar MI, Drake MJ. Invasive urodynamic studies for the management of lower urinary tract symptoms (LUTS) in men with voiding dysfunction. Cochrane Database Syst Rev. 2015 Apr 28;2015(4):CD011179. doi: 10.1002/14651858.CD011179.pub2. PMID: 25918922; PMCID: PMC10823470.
Denisenko AA, Clark CB, D'Amico M, Murphy AM. Evaluation and management of female urinary incontinence. Can J Urol. 2021 Aug;28(S2):27-32. PMID: 34453426
EAU Guidelines. Edn. presented at the EAU Annual Congress Paris 2024. ISBN 978-94-92671-23-3
Geng, V., et al., Catheterisation Indwelling catheters in adults – Urethral and Suprapubic - Evidence-based Guidelines for Best Practice in Urological Health Care 2012. EAUN, Arnhem The Netherlands. Access date December 2022.
Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn. 2008;27(8):749-57. doi: 10.1002/nau.20635. PMID: 18951445.
Subak LL, King WC, Belle SH, Chen JY, Courcoulas AP, Ebel FE, Flum DR, Khandelwal S, Pender JR, Pierson SK, Pories WJ, Steffen KJ, Strain GW, Wolfe BM, Huang AJ.
Urinary Incontinence Before and After Bariatric Surgery. JAMA Intern Med. 2015 Aug;175(8):1378-87. doi: 10.1001/jamainternmed.2015.2609. PMID: 26098620; PMCID: PMC4529061.
Leshem A, Shimonov M, Amir H, Gordon D, Groutz A. Effects of Bariatric Surgery on Female Pelvic Floor Disorders. Urology. 2017 Jul;105:42-47. doi: 10.1016/j.urology.2017.03.003. Epub 2017 Mar 16. PMID: 28315786
Knepfler T, Valero E, Triki E, Chilintseva N, Koensgen S, Rohr S. Bariatric surgery improves female pelvic floor disorders. J Visc Surg. 2016 Apr;153(2):95-9. doi: 10.1016/j.jviscsurg.2015.11.011. epub 2015 Dec 8. PMID: 26678846.
Fader M, Cottenden A, Getliffe K, Gage H, Clarke-O'Neill S, Jamieson K, Green N, Williams P, Brooks R, Malone-Lee J. Absorbent products for urinary/faecal incontinence: a comparative evaluation of key product designs. Health Technol Assess. 2008 Jul;12(29):iii-iv, ix-185. doi: 10.3310/hta12290. PMID: 18547500.
Jahn P, Beutner K, Langer G. Types of indwelling urinary catheters for long-term bladder drainage in adults. Cochrane Database Syst Rev. 2012 Oct 17;10:CD004997. doi: 10.1002/14651858.CD004997.pub3. PMID: 23076911.
Hunter, Kathleen & Bharmal, Aamir & Moore, Katherine. (2013). Long-Term Bladder Drainage: Suprapubic Catheter Versus Other Methods: A Scoping Review. Neurourology and urodynamics. 32. 10.1002/nau.22356.
Tauzin-Fin, P., et al. Sublingual oxybutynin reduces postoperative pain related to indwelling bladder catheter after radical retropubic prostatectomy. Br J Anaesth, 2007. 99: 572.
Tijani, K.H., et al. Role of tolterodine in the management of postoperative catheter-related bladder discomfort: Findings in a Nigerian teaching hospital. Niger J Clin Pract, 2017. 20: 484.
Young, M.J., et al. Another Therapeutic Role for Intravesical Botulinum Toxin: Patients with Long-stay Catheters and Refractory Bladder Pain and Catheter Bypass Leakage. Eur Urol Focus, 2020. 6: 339.
Fisher, H., et al. Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial. Lancet Infect Dis. , 2018. 18: 957.
Miller JM, Ashton-Miller JA, DeLancey JO. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998 Jul;46(7):870-4. doi: 10.1111/j.1532-5415.1998.tb02721.x. PMID: 9670874.
Zubieta M, Carr RL, Drake MJ, Bø K. Influence of voluntary pelvic floor muscle contraction and pelvic floor muscle training on urethral closure pressures: a systematic literature review. Int Urogynecol J. 2016 May;27(5):687-96. doi: 10.1007/s00192-015-2856-9. Epub 2015 Sep 25. PMID: 26407561.
Hoff Brækken I, Majida M, Engh ME, Bø K. Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography: a randomized controlled trial. Obstet Gynecol. 2010 Feb;115(2 Pt 1):317-324. doi: 10.1097/AOG.0b013e3181cbd35f. Erratum in: Obstet Gynecol. 2010 May;115(5):1092. Hoff Braekken, Ingeborg [corrected to Braekken, Ingeborg Hoff]. PMID: 20093905.
Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018 Oct 4;10(10):CD005654. doi: 10.1002/14651858.CD005654.pub4. PMID: 30288727; PMCID: PMC6516955.
Herderschee R, Hay-Smith EJ, Herbison GP, Roovers JP, Heineman MJ. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009252. doi: 10.1002/14651858.CD009252. PMID: 21735442.
Hagen S, McClurg D, Bugge C, Hay-Smith J, Dean SG, Elders A, Glazener C, Abdel-Fattah M, Agur WI, Booth J, Guerrero K, Norrie J, Kilonzo M, McPherson G, McDonald A, Stratton S, Sergenson N, Grant A, Wilson L. Effectiveness and cost-effectiveness of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: protocol for the OPAL randomised trial. BMJ Open. 2019 Feb 19;9(2):e024153. doi: 10.1136/bmjopen-2018-024153. PMID: 30782895; PMCID: PMC6411252.
Herbison GP, Dean N. Weighted vaginal cones for urinary incontinence. Cochrane Database Syst Rev. 2013 Jul 8;2013(7):CD002114. doi: 10.1002/14651858.CD002114.pub2. PMID: 23836411; PMCID: PMC7086390.
NICE Guidance - Urinary incontinence and pelvic organ prolapse in women: management. BJU Int, 2019. 123: 777.
Dumoulin C, Hunter KF, Moore K, Bradley CS, Burgio KL, Hagen S, Imamura M, Thakar R, Williams K, Chambers T. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence. Neurourol Urodyn. 2016 Jan;35(1):15-20. doi: 10.1002/nau.22677. Epub 2014 Nov 15. PMID: 25400065.
Stewart F, Berghmans B, Bø K, Glazener CM. Electrical stimulation with non-implanted devices for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017 Dec 22;12(12):CD012390. doi: 10.1002/14651858.CD012390.pub2. PMID: 29271482; PMCID: PMC6486295.
Bø K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999 Feb 20;318(7182):487-93. doi: 10.1136/bmj.318.7182.487. PMID: 10024253; PMCID: PMC27740.
Gilling PJ, Wilson LC, Westenberg AM, McAllister WJ, Kennett KM, Frampton CM, Bell DF, Wrigley PM, Fraundorfer MR. A double-blind randomized controlled trial of electromagnetic stimulation of the pelvic floor vs sham therapy in the treatment of women with stress urinary incontinence. BJU Int. 2009 May;103(10):1386-90. doi: 10.1111/j.1464-410X.2008.08329.x. Epub 2009 Jan 14. PMID: 19154474.
Lai X, Zhang J, Chen J, Lai C, Huang C. Is electroacupuncture safe and effective for treatment of stress urinary incontinence in women? A systematic review and meta-analysis. J Int Med Res. 2020 Oct;48(10):300060520948337. doi: 10.1177/0300060520948337. PMID: 33045874; PMCID: PMC7570783.
Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev. 2012 Oct 17;10(10):CD001405. doi: 10.1002/14651858.CD001405.pub3. PMID: 23076892; PMCID: PMC7086391.
Lyytinen H, Pukkala E, Ylikorkala O. Breast cancer risk in postmenopausal women using estrogen-only therapy. Obstet Gynecol. 2006 Dec;108(6):1354-60. doi: 10.1097/01.AOG.0000241091.86268.6e. PMID: 17138766.
Yumru AE, Bozkurt M, Inci Coşkun E, Baykan G. The use of local 17beta-oestradiol treatment for improving vaginal symptoms associated with post-menopausal oestrogen deficiency. J Int Med Res. 2009 Jan-Feb;37(1):198-204. doi: 10.1177/147323000903700124. PMID: 19215691.
Mettler L, Olsen PG. Long-term treatment of atrophic vaginitis with low-dose oestradiol vaginal tablets. Maturitas. 1991 Dec;14(1):23-31. doi: 10.1016/0378-5122(91)90144-f. PMID: 1791769.
Castellani D, Saldutto P, Galica V, Pace G, Biferi D, Paradiso Galatioto G, Vicentini C. Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence. Urol Int. 2015;95(4):417-21. doi: 10.1159/000381989. Epub 2015 May 30. PMID: 26043913.
Weber MA, Kleijn MH, Langendam M, Limpens J, Heineman MJ, Roovers JP. Local Oestrogen for Pelvic Floor Disorders: A Systematic Review. PLoS One. 2015 Sep 18;10(9):e0136265. doi: 10.1371/journal.pone.0136265. PMID: 26383760; PMCID: PMC4575150.
Jackson S, Shepherd A, Brookes S, Abrams P. The effect of oestrogen supplementation on post-menopausal urinary stress incontinence: a double-blind placebo-controlled trial. Br J Obstet Gynaecol. 1999 Jul;106(7):711-8. doi: 10.1111/j.1471-0528.1999.tb08372.x. PMID: 10428529.
Fantl JA, Bump RC, Robinson D, McClish DK, Wyman JF. Efficacy of estrogen supplementation in the treatment of urinary incontinence. The Continence Program for Women Research Group. Obstet Gynecol. 1996 Nov;88(5):745-9. doi: 10.1016/0029-7844(96)00281-5. PMID: 8885906.
Grady D, Brown JS, Vittinghoff E, Applegate W, Varner E, Snyder T; HERS Research Group. Postmenopausal hormones and incontinence: the Heart and Estrogen/Progestin Replacement Study. Obstet Gynecol. 2001 Jan;97(1):116-20. doi: 10.1016/s0029-7844(00)01115-7. PMID: 11152919.
Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM, Iglesia C, Aragaki A, Naughton MJ, Wallace RB, McNeeley SG. Effects of estrogen with and without progestin on urinary incontinence. JAMA. 2005 Feb 23;293(8):935-48. doi: 10.1001/jama.293.8.935. PMID: 15728164.
Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33. doi: 10.1001/jama.288.3.321. PMID: 12117397.
Steinauer JE, Waetjen LE, Vittinghoff E, Subak LL, Hulley SB, Grady D, Lin F, Brown JS. Postmenopausal hormone therapy: does it cause incontinence? Obstet Gynecol. 2005 Nov;106(5 Pt 1):940-5. doi: 10.1097/01.AOG.0000180394.08406.15. PMID: 16260510; PMCID: PMC1557396.
Goldstein SR, Johnson S, Watts NB, Ciaccia AV, Elmerick D, Muram D. Incidence of urinary incontinence in postmenopausal women treated with raloxifene or estrogen. Menopause. 2005 Mar;12(2):160-4. doi: 10.1097/00042192-200512020-00010. PMID: 15772563.
Molander U, Milsom I, Ekelund P, Mellström D, Eriksson O. Effect of oral oestriol on vaginal flora and cytology and urogenital symptoms in the post-menopause. Maturitas. 1990 Jun;12(2):113-20. doi: 10.1016/0378-5122(90)90089-o. PMID: 2255263.
Basu M, Duckett JR. Update on duloxetine for the management of stress urinary incontinence. Clin Interv Aging. 2009;4:25-30. Epub 2009 May 14. PMID: 19503763; PMCID: PMC2685222.
Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Annals of Internal Medicine. 2008 Mar;148(6):459-473. DOI: 10.7326/0003-4819-148-6-200803180-00211. PMID: 18268288.
Mariappan P, Alhasso A, Ballantyne Z, Grant A, N'Dow J. Duloxetine, a serotonin and noradrenaline reuptake inhibitor (SNRI) for the treatment of stress urinary incontinence: a systematic review. Eur Urol. 2007 Jan;51(1):67-74. doi: 10.1016/j.eururo.2006.08.041. Epub 2006 Sep 15. PMID: 17014950.
Li J, Yang L, Pu C, Tang Y, Yun H, Han P. The role of duloxetine in stress urinary incontinence: a systematic review and meta-analysis. Int Urol Nephrol. 2013 Jun;45(3):679-86. doi: 10.1007/s11255-013-0410-6. Epub 2013 Mar 16. PMID: 23504618.
Ghoniem GM, Van Leeuwen JS, Elser DM, Freeman RM, Zhao YD, Yalcin I, Bump RC; Duloxetine/Pelvic Floor Muscle Training Clinical Trial Group. A randomized controlled trial of duloxetine alone, pelvic floor muscle training alone, combined treatment and no active treatment in women with stress urinary incontinence. J Urol. 2005 May;173(5):1647-53. doi: 10.1097/01.ju.0000154167.90600.c6. PMID: 15821528.
Bump RC, Voss S, Beardsworth A, Manning M, Zhao YD, Chen W. Long-term efficacy of duloxetine in women with stress urinary incontinence. BJU Int. 2008 Jul;102(2):214-8. doi: 10.1111/j.1464-410X.2008.07577.x. Epub 2008 Jul 1. PMID: 18422764.
Vella M, Duckett J, Basu M. Duloxetine 1 year on: the long-term outcome of a cohort of women prescribed duloxetine. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Jul;19(7):961-4. doi: 10.1007/s00192-008-0564-4. Epub 2008 Jan 30. PMID: 18231697.
Maund E, Guski LS, Gøtzsche PC. Considering benefits and harms of duloxetine for treatment of stress urinary incontinence: a meta-analysis of clinical study reports. CMAJ. 2017 Feb 6;189(5):E194-E203. doi: 10.1503/cmaj.151104. Epub 2016 Nov 14. PMID: 28246265; PMCID: PMC5289870.
Acharya N, Rosen AS, Polzer JP, D'Souza DN, Perahia DG, Cavazzoni PA, Baldessarini RJ. Duloxetine: meta-analyses of suicidal behaviors and ideation in clinical trials for major depressive disorder. J Clin Psychopharmacol. 2006 Dec;26(6):587-94. doi: 10.1097/01.jcp.0000246216.26400.db. Erratum in: J Clin Psychopharmacol. 2007 Feb;27(1):57. PMID: 17110815.
Klarskov N, Cerneus D, Sawyer W, Newgreen D, van Till O, Lose G. The effect of single oral doses of duloxetine, reboxetine, and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry. Neurourol Urodyn. 2018 Jan;37(1):244-249. doi: 10.1002/nau.23282. Epub 2017 Apr 18. PMID: 28419624.
Ali ASM, Anderson CS. Gepotidacin, a new first-in-class antibiotic for treating uncomplicated urinary tract infection. Lancet. 2024 Feb 24;403(10428):702-703. doi: 10.1016/S0140-6736(23)02697-1. Epub 2024 Feb 8. PMID: 38342129.
Mizutani H, Sakakibara F, Komuro M, Sasaki E. TAS-303, a Novel Selective Norepinephrine Reuptake Inhibitor that Increases Urethral Pressure in Rats, Indicating Its Potential as a Therapeutic Agent for Stress Urinary Incontinence. J Pharmacol Exp Ther. 2018 Aug;366(2):322-331. doi: 10.1124/jpet.118.248039. epub 2018 Jun 6. PMID: 29875227.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Klara Wojciechowska, Monika Turek, Joanna Skotnicka, Aleksandra Jaroń, Katarzyna Jastrzębska, Karolina Piątkowska, Karolina Błaszczak, Maria Witkowska, Tymoteusz Ślósarz, Maciej Witkowski
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 163
Number of citations: 0
