ACP releases clinical practice guideline on nonsurgical management of UI in women

Women with stress urinary incontinence (UI) should perform pelvic floor muscle training, commonly known as Kegel exercises, to help manage the condition, according to a new clinical practice guideline from the American College of Physicians.

The guideline, which appears in the Sept. 16 Annals of Internal Medicine, is based on a systematic review of English-language studies published from 1990 through December 2013 on nonsurgical primary care treatment of UI in women. Such nonsurgical treatments as botulinum toxin or electrical stimulation were not included in the review because they are not typically used in primary care. Outcomes evaluated included continence, improvement in UI, quality of life, adverse effects, and discontinuation related to adverse events.

The resulting recommendations are as follows:

• ACP recommends first-line treatment with pelvic floor muscle training in women with stress UI (strong recommendation, high-quality evidence).
• ACP recommends bladder training in women with urgency UI (strong recommendation, moderate-quality evidence).
• ACP recommends pelvic floor muscle training with bladder training in women with mixed UI (strong recommendation, moderate-quality evidence).
• ACP recommends against treatment with systemic pharmacologic therapy for stress UI (strong recommendation, low-quality evidence).
• ACP recommends pharmacologic treatment in women with urgency UI if bladder training was unsuccessful. Clinicians should base the choice of pharmacologic agents on tolerability, adverse effect profile, ease of use, and cost of medication (strong recommendation, high-quality evidence).
• ACP recommends weight loss and exercise for obese women with UI (strong recommendation, moderate-quality evidence).

The guideline authors noted that a majority of women with UI never report it to physicians and said that physicians should be proactive in asking women about UI symptoms. They also pointed out that many of the included studies did not include full details of the patient populations studied, including whether they had been previously treated for UI, and stated that this could influence treatment response.

The full guideline is available free of charge online.