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Scientific Review

Jayna M. Holroyd-Leduc, MD; Sharon E. Straus, MD

JAMA. 2004;291:986-995.

Context  Urinary incontinence is a common health problem among women that negatively impacts quality of life. Therefore, it is important that primary care physicians have an understanding of how to manage urinary incontinence effectively.

Objective  To review the most recent, high-quality evidence regarding the etiology and management of urinary incontinence in women.

Data Sources and Study Selection  Searches of MEDLINE, EMBASE, The Cochrane Library, and the ACP Journal Club were performed to identify English-language articles published between 1998-2003 that focused on the etiology or treatment of urinary incontinence in adult women. The references of each retrieved article were reviewed and an expert in the field was contacted to identify additional relevant articles.

Data Extraction  Using a combination of more than 80 search terms, we included articles of etiology that were cohort studies, case-control studies, cross-sectional studies, or systematic reviews of cohort, case-control, and/or cross-sectional studies. Studies of treatment had to be randomized controlled trials or systematic reviews of randomized controlled trials. The quality of each article was assessed independently by each author and inclusion (n = 66) was determined by consensus.

Data Synthesis  Multiple factors have been found to be associated with urinary incontinence, some of which are amenable to modification. Factors associated with incontinence include age, white race, higher educational attainment, pregnancy-related factors, gynecological factors, urological and gastrointestinal tract factors, comorbid diseases, higher body mass index, medications, smoking, caffeine, and functional impairment. There are several effective nonpharmacological treatments including pelvic floor muscle training, electrical stimulation, bladder training, and prompted voiding. Anticholinergic drugs are effective in the treatment of urge urinary incontinence. Several surgical interventions are effective in the management of stress incontinence, including open retropubic colposuspension and suburethral sling procedure.

Conclusion  Urinary incontinence in women is an important public health concern, and effective treatment options exist.

Author Affiliations: San Francisco Veterans Affairs Medical Center, San Francisco and Division of Geriatrics, Department of Medicine, University of California, San Francisco (Dr Holroyd-Leduc) and Division of General Internal Medicine, University Health Network, University of Toronto, Toronto, Ontario (Dr Straus).

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