Behavioral therapy is as good as, and in some cases may be better than, medication alone for treating urinary incontinence in women, according to a network meta-analysis.
The study also found that hormones and periurethral bulking agents may not be much better than no treatment at all.
The results, published online on March 19 in Annals of Internal Medicine, confirm past systematic reviews and are consistent with international guidelines.
"[B]ehavioral therapy, alone or combined with other interventions, is generally more effective than other first- and second-line monotherapies for both stress and urgency [urinary incontinence]," write Ethan Balk, MD, MPH, of Brown University School of Public Health, Providence, Rhode Island, and colleagues.
Medications have the disadvantage of bothersome side effects, such as dry mouth, nausea, and fatigue.
Many women suffer from urinary incontinence, especially if they are older or have had children. The condition can have wide-ranging effects on physical, psychological, and social well-being. Restrictions in lifestyle are not uncommon.
To compare the effectiveness of treatments for urinary incontinence, researchers searched six databases, without language restriction, from inception to August 2018. Ultimately, their meta-analysis included 84 randomized controlled trials of nonsurgical therapies for urinary incontinence in nonpregnant women. All of the trials had a minimum follow-up of 4 weeks. Urinary incontinence was classified as stress (involuntary loss of urine with physical exertion, sneezing, or coughing) or urge (compulsion to urinate that cannot be delayed). Cure was defined as resolution of incontinence, not necessarily a permanent cure of the underlying problem.
Among first- and second-line interventions for stress urinary incontinence, alpha agonists alone and hormones alone were no different from no treatment for achieving cure (odds ratio [OR], 1.22; 95% confidence interval [CI], 0.61 – 2.45; moderate strength of evidence; and OR, 2.89; 95% CI, 0.76 – 11.0; low strength of evidence, respectively).
Behavioral therapy was more effective than alpha agonists alone for achieving cure (OR, 2.50; 95% CI, 1.19 – 5.28; moderate strength of evidence).
Indirect evidence suggested that adding behavioral therapy to hormone therapy was also more effective than alpha agonists alone for achieving cure (OR, 3.62; 95% CI, 0.98 – 13.4; moderate strength of evidence).
For improving stress urinary incontinence, behavioral therapy was more effective than either hormones alone (OR, 10.2; 95% CI, 1.39 – 4.50; moderate strength of evidence) or alpha agonists alone (OR, 2.50; 95% CI 1.39 – 4.50; moderate strength of evidence).
Among third-line interventions for stress urinary incontinence, neuromodulation was more effective than no treatment for achieving cure (OR, 3.34; 95% CI, 2.12 – 5.26; high strength of evidence). In contrast, intravesical pressure release and periurethral bulking were generally not effective for achieving cure or improvement.
Among first- and second-line interventions for urge urinary incontinence, behavioral therapy was significantly more effective than anticholinergics alone for achieving cure (OR, 1.57; 95% CI, 1.02 – 2.43; high strength of evidence).
Among third-line interventions for urge urinary incontinence, botox and neuromodulation were more effective than no treatment for achieving cure (OR, 5.66; 95% CI, 2.80 – 11.4, high strength of evidence; and OR, 3.34; 95% CI, 2.12 – 5.26; high strength of evidence).
The authors note that most studies showed low or moderate risk for bias. The analyses were limited by few head-to-head comparisons and by differences across studies with respect to severity of urinary incontinence and past treatment.
The study was funded by the the Agency for Healthcare Research and Quality of the US Department of Health and Human Services. The authors have disclosed no relevant financial relationships.
Ann Intern Med. Published online March 19, 2019. Abstract
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Cite this: Behavioral Therapy as Good as Meds for Incontinence - Medscape - Mar 19, 2019.