Urinary incontinence is defined as the involuntary loss of bladder control (1;2). There are various types of urinary incontinence. Three main types include stress, urgency, and mixed incontinence. Stress incontinence involves unintentionally leaking urine when exerting yourself, such as while sneezing. Urgency incontinence is the involuntary loss of urine during or right after a sudden urge to urinate. Mixed incontinence is a combination of multiple types (1).
A leaky bladder may seem like a mere inconvenience, but this is far from the truth. Its effects include major depression, distress, social isolation, urinary tract infections, pressure ulcers, interference with activities of daily living, and a reduction in quality of life, to name a few (1;3-6). In Canada, over three million people deal with urinary incontinence. Although both men and women are affected by this condition, it is more prevalent in women. In fact, 33% of Canadian women over 40 report experiencing symptoms of urinary incontinence versus 16% of men (2).
Luckily, various treatments that aim to help manage or cure urinary incontinence are available. These include conservative treatments—such as mechanical devices, physical therapies, education, behavioural and lifestyle advice, psychological interventions, and complementary therapies—that are often the first line of treatment before trialing options like medication or surgery. A recent overview of systematic reviews summarized the effectiveness of conservative treatments in women (1).
How did these conservative treatments hold-up?
What the research tells us
The review looked at various conservative treatments, types of urinary incontinence, and comparisons. The certainty of the evidence ranged from very low to high and most of the results were based on analyses containing data from only a single trial. Overall, this underscores the need for more research and higher-quality evidence. That said, the review did highlight several key findings based on moderate-to-high certainty evidence for pelvic floor muscle training, weight loss, vaginal cones, and electrical stimulation compared to no treatment, usual care, placebo, or sham (pretend) treatment.
Pelvic floor muscle training, which involves engaging in exercises that contract and relax the pelvic floor muscles, was found to improve or cure urinary incontinence and boost quality of life in women with most types of urinary incontinence. Characteristics like: 1) more intense exercises and frequent training, 2) a greater level of individual supervision from a healthcare professional, and 3) adding on behavioural or adherence strategies that encourage continued practice can enhance the effectiveness of pelvic floor muscle training. Weight loss, a lifestyle modification, was also shown to improve or cure urinary incontinence in women with most types of urinary incontinence.
Additionally, vaginal cones, which are devices that vary in size and weight, showed benefits. These devices are placed in the vagina, and to keep the device from falling, the pelvic floor muscles need to be contracted. This helps to strengthen these muscles. Vaginal cones may improve or cure urinary incontinence in women with stress incontinence.
Finally, electrical stimulation, which involves implantable or non-implantable devices that send electric currents to nerves or muscles involved in bladder function, may improve or cure urinary incontinence in women with urgency incontinence (1).
These results are a lot to unpack. The best place to start is consulting with your healthcare team if you are experiencing symptoms of urinary incontinence. This will help you identify the type of incontinence you have. Thereby setting you up for a discussion of all available treatment options and their pros and cons, including conservative treatments. Together you can choose the treatment that best suits your needs.
