What is urinary incontinence?

Bladder problems are common in women. Having to go to the toilet frequently, urgently and sometimes not making it in time is called urgency urinary incontinence. Urgency urinary incontinence occurs when, for some reason, the signals telling women to empty their bladder are much stronger and occur more often than necessary. Leaking when sneezing or exercising is called stress urinary incontinence, and can happen if the muscles controlling the outlet from the bladder are weaker than they should be. Women can also have a mixture of these two conditions, which is called mixed urinary incontinence.

Symptoms of bladder problems can cause a lot of distress. For example, women can often be reluctant to go out and may fear going for walks or taking part in exercise classes. Often these women can feel isolated and their quality of life is significantly poorer compared to women without bladder symptoms.

How is urinary incontinence treated?

Treatment options for urinary incontinence mainly include 'conservative treatment' (avoiding invasive methods), medication and surgery. Conservative treatments should be offered first and these include training of the pelvic floor muscle (muscle between the tail bone (coccyx) and pubic bone that support the bladder, bowel, vagina, and womb) (with and without add-on treatments such as electrical stimulation), bladder training and devices. These are usually provided by physiotherapists or nurses who have had specialist training.

What did we aim to do?

There are a growing number of Cochrane Reviews relating to conservative management for different types of urinary incontinence, and our aim was to bring together these research findings into one accessible overview document, with input from clinicians and women affected by incontinence.

How up-to-date is this overview?

This overview is up-to-date to 18 January 2021.

What did we do?

We searched for Cochrane Reviews relating to the conservative management of urinary incontinence in women and found 29 relevant reviews. From these, we collated data regarding the type of intervention (treatment) and what it was compared to in tables. The comparison treatment could have been a control (such as a sham (pretend) treatment or usual care), another conservative intervention or a non-conservative intervention. We identified two key outcomes that were important to women: if they were cured or improved and if their quality of life had improved. We assessed the quality of the included reviews and the certainty of the data within these reviews (the extent of our confidence that review results are correct in supporting or rejecting a finding).

Key results

There is high certainty evidence that undertaking pelvic floor muscle training can cure symptoms and improve quality of life for all types of urinary incontinence. There is moderate or high certainty evidence that these pelvic floor muscle exercises work better if they are more intense, have more support from a health professional, and are combined with strategies to support continued use. Lifestyle modifications, such as losing weight and trying to control how often you empty your bladder, may also be beneficial for some types of urinary incontinence. The use of adjuncts, such as electrical stimulation, may also be of benefit, especially for those with mixed or urgency urinary incontinence.

Quality of evidence

Approximately half of our findings provided moderate or high certainty evidence. However, 81% of our findings from analyses within the reviews included data only from one trial. These reviews had not been able to pull together the results of several trials. We could not identify any Cochrane Reviews for some commonly used treatments, such as psychological therapies. Generally, long-term follow-up was lacking and the use of multiple and diverse outcomes limited the possibility of combining results to give meaningful evidence.

Authors' conclusions

There is a lot of evidence for conservative management of urinary incontinence in women and the use of pelvic floor muscle exercises is strongly supported for most patients, regardless of the type of incontinence. However, there are many limitations with the current evidence for conservative treatment of urinary incontinence and often the evidence does not support clear clinical decisions. More research is urgently required to establish high-quality evidence addressing questions which matter to women affected by urinary incontinence.