For Urinary Incontinence, Behavioral Therapies Outperform Meds

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Behavioral therapies are generally more effective than pharmacologic interventions for stress or urge urinary incontinence, according to a network meta-analysis in the Annals of Internal Medicine.

Researchers analyzed 84 studies that examined behavioral therapies (e.g., bladder training), pharmacologic interventions (e.g., hormones, anticholinergics, onabotulinum toxin A), and other nonsurgical interventions (e.g., neuromodulation) for urinary incontinence in nonpregnant women. Among the findings:

• Most interventions — except hormones and periurethral bulking agents — were more effective than no treatment in terms of symptom improvement or cure.

• For stress incontinence, behavioral therapy outperformed hormones and alpha-agonists, while alpha-agonists and neuromodulation outperformed hormones.

• For urgency incontinence, behavioral therapy was superior to anticholinergics, and onabotulinum toxin A was potentially superior to neuromodulation.

• Second-line interventions like alpha-agonists and anticholinergics were tied to adverse events, including dry mouth.

Dr. Andrew Kaunitz of NEJM Journal Watch Women's Health noted, "Behavioral therapy for urinary incontinence requires active participation by the patient (in contrast with medication-only therapy); this report underscores the importance of behavioral therapy."