Urinary incontinence is a common health problem among women that negatively
impacts quality of life. Therefore, it is important that primary care physicians
have an understanding of how to manage urinary incontinence effectively.
To review the most recent, high-quality evidence regarding the etiology
and management of urinary incontinence in women.
Data Sources and Study Selection
Searches of MEDLINE, EMBASE, The Cochrane Library, and the ACP Journal Club were performed to identify English-language articles
published between 1998-2003 that focused on the etiology or treatment of urinary
incontinence in adult women. The references of each retrieved article were
reviewed and an expert in the field was contacted to identify additional relevant
Using a combination of more than 80 search terms, we included articles
of etiology that were cohort studies, case-control studies, cross-sectional
studies, or systematic reviews of cohort, case-control, and/or cross-sectional
studies. Studies of treatment had to be randomized controlled trials or systematic
reviews of randomized controlled trials. The quality of each article was assessed
independently by each author and inclusion (n = 66) was determined by consensus.
Multiple factors have been found to be associated with urinary incontinence,
some of which are amenable to modification. Factors associated with incontinence
include age, white race, higher educational attainment, pregnancy-related
factors, gynecological factors, urological and gastrointestinal tract factors,
comorbid diseases, higher body mass index, medications, smoking, caffeine,
and functional impairment. There are several effective nonpharmacological
treatments including pelvic floor muscle training, electrical stimulation,
bladder training, and prompted voiding. Anticholinergic drugs are effective
in the treatment of urge urinary incontinence. Several surgical interventions
are effective in the management of stress incontinence, including open retropubic
colposuspension and suburethral sling procedure.
Urinary incontinence in women is an important public health concern,
and effective treatment options exist.