Conservative Treatment of Stress Urinary Incontinence in Women

A 10-Year (2004-2013) Scoping Review of the Literature

Louise McIntosh, MSN, BScN, RN; Elizabeth Andersen, PhD, RN; Manuela Reekie, MN, BSN, BSc (Biology), RN

Disclosures

Urol Nurs. 2015;35(4):179-186. 

In This Article

Abstract and Introduction

Abstract

Stress urinary incontinence is a serious threat to the well-being of women worldwide. In this scoping review of the literature, we examined the most prominent research foci between the years 2004 and 2013. In this article, conservative treatment is operationalized as any non-surgical or non-pharmacological treatment modalities that could be carried out by specially trained nurses, physiotherapists, or physicians to treat stress urinary incontinence in women. The two most frequently described or systematically investigated treatment options identified in our review were 1) strengthening pelvic floor muscles with pelvic floor muscle training, including biofeedback and weighted vaginal cones; and 2) the use of intravaginal support devices, such as incontinence pessaries. Other treatment modalities were also explored in the literature review, such as intraurethral devices, behavioral and lifestyle interventions, products, and alternative therapies, such as acupuncture and acupressure. However, the focus of this article is on the two most frequently described options.

Introduction

Stress urinary incontinence (SUI) is defined as the loss of urine that occurs at a time and/or place that is not convenient or appropriate, such as when one coughs, sneezes, engages in physical exertion and sports activities, or even sudden changes in position (Canadian Continence Foundation, 2012; International Continence Society [ICS], 2013; National Association for Continence, 2015). It results when the normal positive urethral closure mechanism is overcome "in the absence of detrusor contraction" (Haylen et al., 2010, p. 14).

Although SUI occurs in men, some estimate that it is more than four times more common in women (Corcos et al., 2006; Farage et al., 2011; Markland, Vaughan, Johnson, Burgio, & Goode, 2011). Known risk factors for female SUI include age; obesity; menopause and the loss of circulating estrogen; low fluid consumption that leads to dry, hard stools; and straining when evacuating the bowels (Abed, & Rogers, 2008; Chong, Khan, & Anger, 2011; Stewart, 2010). Childbirth is also well known to cause pelvic muscle injury that can lead to SUI (Cherniack, 2006). The number of pregnancies and vaginal deliveries impact the woman's predisposition to developing SUI, including "the length of the second stage of delivery (i.e., quick or protracted with many hours of pushing), whether instruments such as forceps or ventouse were used, whether there was a tear and/or stitches" (Stewart, 2010, p. 526). In addition, excessive fluid consumption may also lead to SUI due to overfilling of the bladder (Grewar & McLean, 2008).

This article focuses on describing two of the most commonly reported conservative (nonsurgical and non pharmacological) treatment options currently available for women with SUI, and on identifying the benefits and drawbacks of these treatments. This information is important for health professionals and women worldwide who seek effective, low-risk treatments for SUI. Other treatment modalities were also explored in the literature review, such as intraurethral devices, behavioral and lifestyle interventions, products, and alternative therapies, such as acupuncture and acupressure. However, the focus of this article is on the two most frequently described options.

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