Which nonsurgical options are effective for the treatment of female urinary incontinence?

In this study sponsored by the US federal government, Shamliyan et al. extracted data from 96 randomized controlled trials and 3 meta-analyses, and reviewed the evidence of nonsurgical treatment for female urinary incontinence (UI). Pelvic-floor muscle training alone, or in combination with bladder training, was found to be effective in improving UI compared with standard care. Generalizing the clinical relevance of these studies, however, was difficult because of heterogeneity between the trials. Anticholinergic agents were also moderately effective, but adverse effects were frequent. Additionally, slight improvements on subjective variables were noted with duloxetine, but adverse effects were numerous, and some were serious. The aim of conservative treatment for UI is often to improve quality of life rather than cure the disorder; if women are properly counseled, conservative therapies have a valuable place in the management of UI.