Urinary Incontinence

ACP Releases New Urinary Incontinence Guidelines

The American College of Physicians has released new guidelines for the nonsurgical treatment of urinary incontinence (UI) in women in the primary care setting.

The ACP defined 2 types of UI in women—stress and urgency. Stress deals with a failure of the urethral sphincter, while urgency in the loss of urine attributed to sudden compelling urges.
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The guidelines are based on a review of literature on the nonsurgical management of UI in women from 1990 to 2013. From the review, the ACP developed the following recommendations:

  • First-line treatment with pelvic floor muscle training should be employed in women with stress UI, bladder training in women with urgency UI, and pelvic floor muscle training with bladder training in women with mixed UI.
  • Treatment with systemic pharmacologic therapy for stress UI should not be used.
  • Pharmacologic treatment should be used in women with urgency UI if bladder training was unsuccessful, but not in those with stress UI.
  • Weight loss and exercise should be recommended for obese women with UI.

The guidelines also stress that physicians should not assume that all patients with UI will report it, and should proactively ask their patients.

“Asking such questions as ‘Do you have a problem with urinary incontinence (of your bladder) that is bothersome enough that you would like to know more about how it could be treated?’ as part of a quality improvement intervention has been shown to increase appropriate care by 15% in patients aged 75 years or older,” they concluded.

The complete guidelines are available in current issue of Annals of Internal Medicine.

—Michael Potts

Qaseem A, Dallas P, Forciea MA, et al. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(6):429-440.