Urinary incontinence is common among women and becomes more prevalent with increasing age. A recent literature review (http://bit.ly/L1P6W7) published in Comparative Effectiveness Review (number 36) from the Agency for Healthcare Research and Quality evaluated the clinical efficacy and comparative effectiveness of pharmacologic and nonpharmacologic therapies for stress incontinence, urge incontinence, and mixed urinary incontinence.

Studies evaluated a range of medications for incontinence, including anticholinergics, antimuscarinics, and hormones. Anticholinergics resulted in a low rate of improvement in incontinence (fewer than 200 cases of continence attributable to anticholinergics per 1,000 patients). In contrast, antimuscarinic drugs (such as fesoterodine, oxybutynin, solifenacin, tolterodine, and trospium) increased continence, although medication discontinuation caused by adverse effects was noted with oxybutynin, solifenacin, fesoterodine, and trospium in women with urge incontinence. Low-dose topical estrogen improved stress incontinence in some postmenopausal women, but the adverse effects of the antidepressant duloxetine outweighed the improvements the drug provided. Overall, adverse effects-including dry mouth, constipation, and blurred vision-resulted in poor adherence to pharmacologic treatments.

Studies evaluating nonpharmacologic approaches to treating stress incontinence primarily focused on pelvic floor-muscle training, intravaginal electrical stimulation, vaginal cones, and magnetic stimulation. Studies evaluating approaches to treating urge incontinence involved bladder training and percutaneous tibial nerve stimulation. Treatments for mixed incontinence included specialized continence services and weight loss. Overall, these treatments provided significant clinical benefit without the adverse effects associated with drug therapies. Pelvic floor-muscle training was most effective in achieving continence; however, studies showed poor adherence to both this and bladder training.

This comprehensive report showed that some medications can provide benefit, but adverse effects lead to poor adherence. And although nonpharmacologic treatments such as muscle training and electrical stimulation provide significant clinical benefit with less risk of adverse effects, they are still associated with poor adherence.