Urinary Incontinence: evidence on conservative management

Authors

  • Julia Maria Salgado Carvalho
  • João Augusto Cegarra Quintiliano
  • Aline Christie Salgado de Oliveira
  • Isadora Pinheiro Urquieta
  • Jade Soares Dória
  • Paulo Henrique Barreto de Jesus
  • Pedro Cariello Ramos Saint Brisson
  • Roberta Kayane Silva Leal

DOI:

https://doi.org/10.34119/bjhrv6n5-013

Keywords:

Urinary Incontinence, conservative treatment, pelvic floor disorders, gynecology, physical therapy modalities

Abstract

Urinary incontinence in women is a condition of high incidence and is associated with an impact on quality of life. Conservative treatment modalities are an important resource in the management of this condition, since they can be prescribed based on the clinical diagnosis without the need for additional tests. The present study aims to gather current evidence on conservative treatment modalities available for female incontinence published in the last 5 years. Conducting the search in the Medline and LILACS databases, 28 articles were identified, categorized with level of evidence 1b and 2b by the Oxford classification, which present original results on physical therapy, medication and behavioral modalities in the non-community treatment of female incontinence. The current state of the art demonstrates a domain of studies with a high degree of evidence involving the treatment modalities associated with the physical therapy practice of pelvic floor muscle training. Evidence from 5 analyzed studies statistically demonstrated the superiority of this method in relation to control groups, or to groups submitted to other interventions. Positive evidence related to transcutaneous electrical stimulation therapies, intravaginal electrical stimulation, duloxetine, noradrenaline receptor inhibitors, continence pessaries, and lifestyle changes was also observed.

References

ABRAMS, P. et al. Incontinence. 6. ed. Bristol: International Continence Society; 2017.

ANDRADE, R. L. et al. An education program about pelvic floor muscles improved women's knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial. J Physiother, v. 64, n. 2, p. 91-96, 2018.

ANTÔNIO, F. I. et al. Intravaginal electrical stimulation increases voluntarily pelvic floor muscle contractions in women who are unable to voluntarily contract their pelvic floor muscles: a randomised trial. J Physiother, v. 68, n. 1, p. 37-42, 2022.

ARIMAN, A. et al. The effect of Mirabegron and Duloxetine combination in mixed-type urinary incontinence treatment. Revista da Associação Médica Brasileira [online]. v. 67, n. 5, p. 713-717, 2021.

ASSIS, T. R. et al. The effect of an exercise program to strengthen pelvic floor muscles in multiparous women. Rev Bras Ginecol Obstet, v. 35, n. 1, p. 10-15, 2013.

ATHANASIOU, S. et al. The effects of duloxetine on urethral function and sphincter morphology. Int Urogynecol J Pelvic Floor Dysfunct, v. 18, n. 7, p. 763-767, 2007.

BARNES, K. L. et al. Home Biofeedback Versus Physical Therapy for Stress Urinary Incontinence: A Randomized Trial. Female Pelvic Med Reconstr Surg, v. 27, n. 10, p. 587-594, 2021.

BEZERRA, L. O. et al. Impact of Pelvic Floor Muscle Training Isolated and Associated with Game Therapy on Mixed Urinary Incontinence: A Randomized Controlled Trial. Games Health J, v. 10, n. 1, p. 43-49, 2021.

BOARETTO, J. A. et al. Comparação entre oxibutinina, eletroestimulação do nervo tibial posterior e exercícios perineais no tratamento da síndrome da bexiga hiperativa. Fisioter. Pesqui. (Online), v. 26, n. 2, p. 127-136, 2019.

BRASIL. Ministério da Saúde. Protocolo Clínico E Diretrizes Terapêuticas Incontinência Urinária Não Neurogênica. Brasília, 2020. 168p.

BREYER, B. N. et al. PRIDE. A Behavioral Weight Loss Program and Nonurinary Incontinence Lower Urinary Tract Symptoms in Overweight and Obese Women with Urinary Incontinence: A Secondary Data Analysis of PRIDE. J Urol, v. 199, n. 1, p. 215-222, 2018.

BRITO, F. A; GENTILLI R. M. L. Inattention to incontinent woman in primary care unit. Fisioter Bras, v. 18, n. 2, p. 205-213, 2017.

BYKOVIENE, L. et al. Pelvic Floor Muscle Training With Or Without Tibial Nerve Stimulation and Lifestyle Changes Have Comparable Effects on The Overactive Bladder. A Randomized Clinical Trial. Urol J, v. 15, n. 4, p. 186-192, 2018.

CAVENAGHI, S. et al. Efeitos da fisioterapia na incontinência urinária feminina. Revista Pesquisa Em Fisioterapia, v. 10, n. 4, p. 658-665, 2020.

CAYIR, G; KIZILKAYA, B. N. The effect of a counseling and training program on the treatment of women with overactive bladder. Psychol Health Med, v. 27, n. 8, p. 1726-1738, 2022.

CENTRE FOR EVIDENCE BASED MEDICINE. Oxford centre for evidence-based

DUE, U. et al. Pelvic floor muscle training with and without supplementary KAATSU for women with stress urinary incontinence - a randomized controlled pilot study. Neurourol Urodyn, v. 38, n. 1, p. 379-386, 2019.

DUMOULIN, C. et al. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence. Neurourol Urodyn, [S.I.], 2016.

EICKMEYER, S. M. Anatomy and Physiology of the Pelvic Floor. Phys Med Rehabil Clin N AM, v. 28, n. 3, p. 455-460, 2017.

ELMELUND, M. The effect of pelvic floor muscle training and intravaginal electrical stimulation on urinary incontinence in women with incomplete spinal cord injury: an investigator-blinded parallel randomized clinical trial. Int Urogynecol J, v. 29, n. 11, p. 1597-1606, 2018.

EVANGELISTA, D. R.; GAZETTA, F. A. D. A.; ASSIS, L. C. Prevalência de incontinência urinária em idosas e impacto na qualidade de vida/ Prevalence of urinary incontinence in elderly women and impact on quality of life. Brazilian Journal of Health Review, v. 4, n. 1, p. 1588–1602, 2021

FIGUEIREDO, V. B. Effects of individual pelvic floor muscle training vs individual training progressing to group training vs group training alone in women with stress urinary incontinence: A randomized clinical trial. Neurourol Urodyn, v. 39, n. 5, p. 1447-1455, 2020.

FITZ, F. F. et al. Pelvic floor muscle training for female stress urinary incontinence: a randomised control trial comparing home and outpatient training. Int Urogynecol J, v. 31, n. 5, p. 989-998, 2020.

FITZ, F. F. et al. Pelvic floor muscle training for overactive bladder symptoms - A prospective study. Rev. Assoc. Med. Bras. (1992), v. 63, n. 12, p. 1032-1038, 2017.

FLEISCHMANN, N. F. A.; BLAIVAS, J. G.; PANAGOPOULOS, G. Sphincteric urinary incontinence: relationship of vesical leak point pressure, urethral mobility and severity of incontinence. The Journal of Urology, v. 169, n. 3, p. 999-1002, 2003.

GIBSON, W. et al. The association between lower urinary tract symptoms and falls: Forming a theoretical model for a research agenda. Neurourol Urodyn, v. 37, p. 501, 2018.

GLEASON, J. L. Caffeine and urinary incontinence in US women. Int Urogynecol J, v. 24, n. 2, p. 295-302, 2012.

GRAY, T. et al. Evaluation of coital incontinence by electronic questionnaire: prevalence, associations and outcomes in women attending a urogynaecology clinic. Int Urogynecol J, v. 29, n. 7, p. 969, 2018.

HAGOVSKA, M. et al. A randomized, intervention parallel multicentre study to evaluate duloxetine and innovative pelvic floor muscle training in women with uncomplicated stress urinary incontinence-the DULOXING study. Int Urogynecol J, v. 32, n. 1, p. 193-201, 2021.

HUNKSKAAR, S. B. K. et al. Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). Incontinence, v. 1, p. 255-312, 2005.

KOLODYNSKA, G.; ZALEWSKI, M. ROZEK-PIECHURA, K. Urinary incontinence in postmenopausal women – causes, symptoms, treatment. Menopause Rev, v. 18, n. 1, p. 46-50, 2019.

LEE, U. J. Prevalence of Urinary Incontinence among a Nationally Representative Sample of Women, 2005-2016: Findings from the Urologic Diseases in America Project. J Urol, v. 205, n. 6, p. 1718, 2021.

LEGENDRE, G. et al. Incidence and remission of urinary incontinence at midlife: a cohort study. J Obstet Gynaecol, v. 122, p. 816, 2015.

LINHARES, M. et al. Comparison of transcutaneous electrical tibial nerve stimulation for the treatment of overactive bladder: a multi-arm randomized controlled trial with blinded assessment. Clinics, v. 76, [S.I.], 2021.

LUGINBUEHL, H. et al. Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: a randomized controlled trial. Int Urogynecol J, v. 33, n. 3, p. 531-540, 2022.

LUKACZ, E. S. Female Urinary Incontinence: Evaluation. UpToDate. 2020. Disponível em: <https://www.uptodate.com/contents/female-urinary-incontinence-evaluation>. Acesso em: 20 nov 2022

MARIAPPAN P. et al. Duloxetine, a serotonin and noradrenaline reuptake inhibitor (SNRI) for the treatment of stress urinary incontinence a systematic review. Eur Urol, v. 51, n. 1, p. 67-74, 2007.

MARQUES, S. A. A et al. Effect of Pelvic Floor and Hip Muscle Strengthening in the Treatment of Stress Urinary Incontinence: A Randomized Clinical Trial. J Manipulative Physiol Ther, v. 43, n. 3, p. 247-256, 2020.

medicine 2011 levels of evidence. Disponível em:

MIZAEI, M. et al. Evaluation of the Clinical Efficacy and Complications of Duloxetine in Comparison to Solifenacin in the Treatment of Overactive Bladder Disease in Women: A Randomized Clinical Trial. Urol J, v. 18, n. 5, p. 543-548, 2021.

MONTEIRO, E. S. et al. Eletroestimulação transcutânea do nervo tibial posterior para bexiga hiperativa neurogênica. Revista Neurociências, v. 18, n. 2, p. 238-243, 2010.

MORONI, R. M. et al. Conservative Treatment of Stress Urinary Incontinence: A Systematic Review with Meta-analysis of Randomized Controlled Trials. Rev Bras Ginecol Obstet, v. 38, n. 2, p. 97-111, 2016.

MUNAGANURU, N. et al. Urine leakage during sexual activity among ethnically diverse, community-dwelling middle-aged and older women. Am J Obstet Gynecol, v. 217, p.439, 2017.

MUTH, C. C. Urinary Incontinence in Women. JAMA, v. 318, n. 16, 2017.

NEKKANTI S. et al. A randomized trial comparing continence pessary to continence device (Poise Impressa®) for stress incontinence. Int Urogynecol J, v. 33, n. 4, p. 861-868, 2022.

NYGAARD, I. Clinical practice. Idiopathic urgency urinary incontinence. N Engl J Med, v. 363, n. 12, p. 1156, 2010.

OLIVEIRA, M. C. E. et al. Comparison of pelvic floor muscle training isolated and associated with weight loss: a randomized controlled trial. Arch Gynecol Obstet, v. 300, n. 5, p. 1343-1351, 2019.

OLIVEIRA, M. C. et al. Evaluation of satisfaction of pelvic floor muscle training isolated and associated with tibial nerve stimulation in women with mixed urinary incontinence: A randomized, single-blinded clinical trial. Eur J Obstet Gynecol Reprod Biol, v. 265, p. 60-65, 2021.

PIACENTINI, F. et al. Influenze della stimolazione transcutanea (Tens) del tibiale posteriore su alcuni parametri cistomano-metrici in pazienti con vescica neurologica - Primi dati su sei pazienti. Acta Biomed Ateneo Parmense, v. 57, p. 109-111, 1986.

PIZZOFERRATO, A. C. et al. Urethral Closure Pressure at Stress: A Predictive Measure for the Diagnosis and Severity of Urinary Incontinence in Women. Int. Neurourol J., n. 21, n. 2, p. 121, 2017.

PTAK, M. et al. The Effect of Pelvic Floor Muscles Exercise on Quality of Life in Women with Stress Urinary Incontinence and Its Relationship with Vaginal Deliveries: A Randomized Trial. Biomed Res Int, v. 6, 2019.

RATNER, E. S. et al. Sexual satisfaction in the elderly female population: A special focus on women with gynecologic pathology. Maturitas, v. 70, n. 3, p. 210-215, 2011.

ROBERT, M.; SCHULZ, J. A.; HARVEY, M. A. Technical update on pessary use. J Obstet Gynaecol Can, v. 35, n. 7, p. 664-674, 2013.

SAHIN, U. I. et al. Effects of external electrical stimulation added to pelvic floor muscle training in women with stress urinary incontinence: A randomized controlled study. Neurourol Urodyn, v. 41, n. 8, p. 1781-1792, 2022.

SANTOS, B. R. et al. Os benefícios da eletroestimulação transcutânea via nervo tibial posterior e parassacral no tratamento de bexiga hiperativa. Fisioter. Bras., v. 20, n. 2, p. 239-248, 2019.

SANTOS, P. F. D. et al. Electrical stimulation of the pelvic floor versus vaginal cone therapy for the treatment of stress urinary incontinence. Rev Bras Ginecol Obstet, v. 31, n. 9, p. 447-452, 2009.

SCHLUTER, P. J. Urinary and fecal incontinence are independently associated with falls risk among older women and men with complex needs: A national population study. Neurourol Urodyn, v. 39, n. 3, p. 945, 2020.

SCHUMPF, L. F. et al. Urinary incontinence and its association with functional physical and cognitive health among female nursing home residents in Switzerland. BMC Geriatr., v. 17, n. 1, p. 17, 2017.

SILVA, E. O. et al. Intervenção fisioterapêutica em mulheres com Incontinência Urinária: uma revisão de literatura. Brazilian Journal of Health Review, v. 6, n. 1, p. 4363–4374, 2023

STASKIN D. et al. Initial assessment of incontinence. In: ABRAMS, P. et al. Incontinence: 3rd International Consultation on Incontinence. Health Publications Ltd, 2005.

SYLAN, R.; BRUCKER, B. Guideline of guidelines: urinary incontinence. BJU Int, v. 117, p. 20-33, 2016.

TAKAHASHI, S. et al. Efficacy and safety of the noradrenaline reuptake inhibitor, TAS-303, in women with stress urinary incontinence: Results of a double-blind, randomized, placebo-controlled, early phase II trial. Int J Urol, v. 28, n. 1, p. 82-90, 2021.

TERLIKOWSKI, R. Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebocontrolled, randomized clinical trial. Int Urogynecol J, v. 24, n. 10, p. 1631-1638, 2013.

TODHUNTER-BROWN, A. et al. Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews 2022, n. 9, 2022.

WADENSTEN, T. et al. A Mobile App for Self-management of Urgency and Mixed Urinary Incontinence in Women: Randomized Controlled Trial. J Med Internet Res, v. 23, n. 4, 2021.

WADENSTEN, T. et al. App-based self-management of urgency and mixed urinary incontinence in women: One-year follow-up. Neurourol Urodyn, v. 41, n. 4, p. 945-954, 2022.

ZOOROB, D.; KARRAM, M. Management of mesh complications and vaginal constriction: a urogynecology perspective. Urol Clin North Am, v. 39, n. 3, p. 413-418, 2012.

Downloads

Published

09/05/2023

How to Cite

CARVALHO, J. M. S.; QUINTILIANO, J. A. C.; DE OLIVEIRA, A. C. S.; URQUIETA, I. P.; DÓRIA, J. S.; DE JESUS, P. H. B.; BRISSON, P. C. R. S.; LEAL, R. K. S. Urinary Incontinence: evidence on conservative management. Brazilian Journal of Health Review, [S. l.], v. 6, n. 5, p. 19598–19611, 2023. DOI: 10.34119/bjhrv6n5-013. Disponível em: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/62712. Acesso em: 20 oct. 2026.

Issue

Section

Original Papers