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Kegel exercises, bladder training, and some medications can resolve women's urinary incontinence

Nearly one in five women up to the age of 44 suffer from urinary incontinence (UI), and as many as 30 percent of elderly women do as well, with many of them suffering from daily incontinence. A systematic review of studies on nonsurgical treatments for UI in women found moderate levels of evidence that pelvic floor muscle training (Kegel exercises) and bladder training resolved women's UI compared with usual care.

Kegel exercises require a woman to concentrate on contracting and relaxing certain muscles of the pelvic floor, which control (and contain) the stream of urine. Anticholinergic drugs also resolved UI compared with placebo, with similar effects from oxybutynin or tolterodine. Duloxetine improved, but did not resolve, UI. The effects of electrostimulation, medical devices, injectable bulking agents, and vaginal estrogen therapy were inconsistent.

Studies are needed on the long-term effects of combined behavioral and drug therapies on incontinence, as well as the effectiveness of various UI interventions in various subgroups, note researchers at the Minnesota Evidence-based Practice Center, which is supported by the Agency for Healthcare Research and Quality (Contract No. 290-02-0009). Their findings were based on analysis of 96 randomized controlled trials and 3 systematic reviews published from 1990 through May 2007 on nonsurgical UI treatments in women.

See "Systematic review: Randomized, controlled trials of nonsurgical treatments for urinary incontinence in women," by Tatyana A. Shamliyan, M.D., M.S., Robert L. Kane, M.D., Jean Wyman, Ph.D., and Timothy J. Wilt, M.D., M.P.H., in the March 18, 2008, Annals of Internal Medicine 148(6), pp. 459-473.

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