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Kegel exercises, bladder training, and weight loss are among
recommendations in ACP's new evidence-based guideline
Guideline | Read
PHILADELPHIA, September 16, 2014 -- Kegel exercises to
strengthen pelvic floor muscles, bladder training, and weight loss
and exercise are effective nonsurgical treatment options for women
with urinary incontinence (UI), according to a new evidence-based
clinical practice guideline from the American College of
Physicians (ACP) published today in Annals of Internal
Medicine, ACP's flagship journal.
"Urinary incontinence is a common problem for women that is
often underreported and underdiagnosed," said Dr. David Fleming,
president, ACP. "Physicians should take an active approach and ask
specific questions such as onset, symptoms, and frequency of
urinary incontinence; it is estimated that about half of the women
with incontinence do not report it to their doctor."
For women with stress UI (the inability to retain urine when
laughing, coughing, or sneezing), ACP recommends Kegel exercises
and recommends against systemic drug therapy. For women with
urgency UI (the loss of urine for no apparent reason after suddenly
feeling the need or urge to urinate), ACP recommends bladder
training. If bladder training is unsuccessful, ACP recommends
medication. Physicians should choose a medication based on adverse
effects and tolerability, ease of use, and cost.
For mixed UI, a combination of stress and urgency incontinence,
ACP recommends Kegel exercises with bladder training. For obese
women with UI, ACP recommends weight loss and exercise.
ACP's guideline, "Nonsurgical Management of Urinary Incontinence
in Women," includes High Value
Care advice to help doctors and patients understand the
benefits, harms, and costs of tests and treatment options so they
can pursue care together that improves health, avoids harms, and
eliminates wasteful practices.
UI contributes to high medical spending in the United States.
Approximately $19.5 billion was spent on UI care in 2004, and UI
accounts for 6 percent of nursing home admissions for elderly
women, costing around $3 billion.
"Physicians should utilize non-drug treatments as much as
possible for urinary incontinence," said Dr. Fleming. "Kegel
exercises for stress UI, bladder training for urgency UI, and Kegel
exercises with bladder training for mixed UI are effective, have
few side effects, and are less expensive than medications. Although
various drugs can improve UI and provide complete continence,
adverse effects often lead many patients to stop taking their
Kegel exercises are a form of pelvic floor muscle training that
comprise relaxing and tightening the muscles that control urine
flow. Bladder training is a form of behavioral therapy that
involves urinating on a set schedule and gradually increasing the
time between urination.
UI affects about 25 percent of women ages 14 to 21, 44 to 57
percent of women ages 40 to 60, and 75 percent of women ages 75 and
older. These estimates may be low as one study showed that at least
half of incontinent women do not report the issue to their
Risk factors for UI include pregnancy, pelvic floor trauma after
vaginal delivery, menopause, hysterectomy, obesity, urinary tract
infections, functional and/or cognitive impairment, chronic cough,
ACP's recommendations are based on published literature in the
English language on nonsurgical management of UI in women from 1990
through December 2013. ACP did not evaluate surgical treatment
options and some nonsurgical treatments, such as botulinum toxin,
percutaneous nerve stimulation, magnetic stimulation, or electrical
stimulation, because these treatments are not typically utilized by
or available to primary care physicians.
About the American College of Physicians
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 141,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
from health to complex illness. Follow ACP on Twitter and Facebook.