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Urinary incontinence in older women: a review of conservative therapeutic interventions

Published online by Cambridge University Press:  03 January 2014

Gemma Wright*
Department of Occupational Therapy, Morriston Hospital, Swansea, UK
Address for correspondence: Gemma Wright, Occupational Therapist, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK. Email:


Urinary incontinence is a highly prevalent yet largely ignored condition that affects older women. Conservative treatment options are widely under-used and containment methods more widely prescribed. This study sought to review the efficacy of conservative approaches and identify which should be recommended. It was found that there is a strong evidence base in support of pelvic floor muscle and behavioural training with biofeedback as a useful adjunctive treatment. The use of therapeutic electrical stimulation was difficult to evaluate due to the different combinations of treatment available and a paucity of evidence of its use with older women. Lifestyle intervention and complementary therapies both demonstrated some positive outcomes. In conclusion it was felt that there is a place for conservative treatments in the management of urinary incontinence rather than relying on containment products. A combination of different treatment approaches is felt to be the most beneficial.

Review Article
Copyright © Cambridge University Press 2013 

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1Kane, R, Ouslander, J, Abrass, I.Essentials of Clinical Geriatrics. New Jersey: The McGraw-Hill Companies Inc; 2004.Google Scholar
2National Institute for Health and Clinical Excellence. Urinary incontinence: the management of urinary incontinence in women. London. 2006. Available at: (accessed 7 Nov 2010).Google ScholarPubMed
3Rutchik, S, Resnick, M.The epidemiology of incontinence in the elderly. Br J Urol 1998; 82 (suppl 1): 14.CrossRefGoogle ScholarPubMed
4Gallo, M, Fallon, P, Staskin, D.Urinary incontinence: steps to evaluation, diagnosis and treatment. Nurse Practitioner 1997; 22: 2124, 26, 28.CrossRefGoogle Scholar
5Dingwall, L, McLafferty, E.Do nurses promote urinary continence in hospitalized older people?: an exploratory study. J Clinical Nursing 2006; 15: 1276–86.CrossRefGoogle Scholar
6Royal College of Physicians. Incontinence Causes, Management and Provision of Services. London: Royal College of Physicians of London; 1995.Google ScholarPubMed
7Robert, M, Ross, S.Conservative management of urinary incontinence. J Obstet Gynaecol Can 2006; 28: 1113–18.CrossRefGoogle ScholarPubMed
8Turner-Stokes, L, Harding, R, Sergeant, J, Lupton, C, McPherson, K.Generating the evidence base for the National Service Framework for long term conditions: a new research typology. Clin Med 2006; 6: 9197.CrossRefGoogle Scholar
9Public Health Resource Unit. Critical appraisals skills programme tools. Available at: (accessed 5 Oct 2010).Google Scholar
10Miller, J.Criteria for therapeutic use of pelvic floor muscle training in women. J Wound, Ostomy Cont Nursing 2002; 29: 301–11.Google ScholarPubMed
11Sari, D, Khorshid, L.The effects of pelvic floor muscle training on stress and mixed urinary incontinence and quality of life. J Wound, Ostomy Cont Nursing 2009; 36: 429–35.CrossRefGoogle Scholar
12Patrick, D, Martin, M, Bushnell, D, Yalcin, I, Wagner, T, Buesching, D.Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument (I-QOL). Urology 1999; 53: 7176.CrossRefGoogle Scholar
13Castro, R, Arruda, R, Zanetti, M, Santos, P, Sartori, M, Girao, M.Single blind randomised controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones and no active treatment in the management of stress urinary incontinence. Clinics 2008; 64: 465–72. Available at: (accessed 10 Oct 2010).CrossRefGoogle Scholar
14Burns, P, Pranikoff, K, Nochajski, T, Hadley, E, Levy, K, Ory, M.A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence on older community-dwelling women. J Gerontol 1993; 48: 167–74.Google ScholarPubMed
15, K, Talseth, T, Vinsnes, A.A randomised control trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstetricia Gynecologica Scand 2000; 79: 598603.CrossRefGoogle Scholar
16, K, Talseth, T, Holme, I.Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. Br Med J 1999; 318: 487–93.CrossRefGoogle ScholarPubMed
17Borello-France, D, Downey, P, Zyczynski, H, Rause, C.Continence and quality-of-life outcomes six months following an intensive pelvic-floor muscle exercise program for female stress urinary incontinence: a randomised trial comparing low- and high- frequency maintenance exercise. Physical Ther 2008; 88: 1545–53.CrossRefGoogle Scholar
18, K, Hagen, R, Kvarstein, B, Jorgensen, J, Larsen, S.Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodynamics 1990; 9: 489502.CrossRefGoogle Scholar
19Janssen, C, Lagro-Janssen, A, Felling, A.The effects of physiotherapy for female urinary incontinence: individual compared with group treatment. Br J Urol Int 2001; 87: 201–6.CrossRefGoogle ScholarPubMed
20Department of Health. Good practice in continence services. Available at: (accessed 5 Dec 2010).Google Scholar
21Wallace, S, Roe, B, Williams, K, Palmer, M.Bladder training for urinary incontinence in adults (review). Victoria: John Wiley and Sons Ltd; 2004.Google Scholar
22Burgio, K, Goode, P.Bladder training and behavioural training. In Haslam, J and Laycock, J (eds), Therapeutic Management of Incontinence and Pelvic Pain, 2nd edn, pp. 127–31. London: Springer-Verlag; 2008.Google Scholar
23Fantl, J, Wyman, J, McClish, Det al.Efficacy of bladder training in older women with urinary incontinence. J Am Med Assoc 1991; 265: 609–13.CrossRefGoogle ScholarPubMed
24Subak, L, Quesenberry, C, Posner, S, Cattolica, E, Soghikian, K.The effect of behavioural therapy on urinary incontinence: a randomised controlled trial. Obstet Gynecol 2002; 100: 7278.Google Scholar
25Dougherty, M, Dwyer, J, Pendergast, Jet al.A randomised trial of behavioural management for continence with older rural women. J Res Nursing Health 2002; 25: 313.CrossRefGoogle Scholar
26Roe, B, Ostaszkiewicz, J, Milne, J, Wallace, S.Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings on theory and methods using metastudy techniques. J Adv Nursing 2006; 57: 314.CrossRefGoogle ScholarPubMed
27Ostaszkiewicz, J, Johnstone, L, Roe, B.Timed voiding for the management of urinary incontinence in adults (review). Victoria: John Wiley and Sons Ltd; 2004.Google Scholar
28Button, D, Roe, B, Webb, C, Frith, T, Colin-Thorne, D, Gardner, L.Continence: promotion and management by primary health care teams: consensus guidelines. London: Whurr Publishers, 1998.Google ScholarPubMed
29Schnelle, J, Traughber, B, Morgan, D, Embry, J, Binion, A, Coleman, A.Management of geriatric incontinence in nursing homes. J Appl Behav Anal 1983; 16: 235–41.CrossRefGoogle Scholar
30Schnelle, J, Traughber, B, Sowell, V, Newman, D, Petrilli, C, Ory, M.Prompted voiding treatment of urinary incontinence in nursing home patients. A behaviour management approach for nursing home staff. J Am Geriatr Soc 1989; 37: 1051–57.CrossRefGoogle ScholarPubMed
31Tobin, G, Brocklehurst, J.The management of urinary incontinence in local authority residential homes for the elderly. Age Ageing 1986; 15: 292–98.CrossRefGoogle ScholarPubMed
32Thompson, D, Smith, D.Continence restoration in the cognitively impaired adult. Geriatric Nursing 1998; 19: 8790.CrossRefGoogle ScholarPubMed
33Engberg, S, Sereika, S, McDowell, J, Weber, E, Brodak, I.Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired home bound older adults. J Wound Ostomy Cont Nursing 2002; 29: 252–65.Google Scholar
34Eustice, S, Roe, B, Paterson, J.Prompted voiding for the management of urinary incontinence in adults (reviews). Truro: John Wiley and Sons Ltd; 2009.Google Scholar
35Burgio, K, Pearce, K, Lucco, A. Staying dry: a practical guide to bladder control. Baltimore: John Hopkins University Press; 1989.Google Scholar
36Burgio, K, Whitehead, W, Engel, B.Urinary incontinence in the elderly. Bladder-sphincter biofeedback and toileting skills training. Annals Intern Med 1985; 103: 507–15.CrossRefGoogle ScholarPubMed
37Borello-France, D, Burgio, K, Goode, Pet al.Adherence to behavioural interventions for urge incontinence when combined with drug therapy: adherence rates, barriers and predictors. Physical Therapy 2010; 90: 1493–505.CrossRefGoogle Scholar
38Abrams, P, Cardozo, L, Fall, Met al.The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the international continence society. Neurourol Urodyn 2002; 21: 167–78.CrossRefGoogle ScholarPubMed
39Bump, R, Hurt, W, Fantl, J, Wyman, J.Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 1991; 165: 322–29.CrossRefGoogle ScholarPubMed
40Wyman, J.Treatment of urinary incontinence in men and older women: the evidence shows the efficacy of a variety of techniques. Am J Nursing 2003; 103 (suppl 3): 2635.CrossRefGoogle Scholar
41Cammu, H, Nylen, M.Pelvic floor exercises versus vaginal weight cones in genuine stress incontinence. Eur J Obstet Gynecol Reprod Biol 1998; 77: 8993.CrossRefGoogle ScholarPubMed
42Seo, J, Yoon, H, Ho Kim, Y.A randomised prospective study comparing new vaginal cone and FES-Biofeedback. Yonsei Med J 2004; 45: 879–84.CrossRefGoogle Scholar
43Berghmans, L, Frederiks, C, de Bie, Ret al.Efficacy of biofeedback, when included with pelvic floor muscle exercise treatment, for genuine stress incontinence. Neurourol Urodyn 1996; 15: 3752.3.0.CO;2-G>CrossRefGoogle Scholar
44Bower, W.Electrical stimulation. In Baessler, K, Schüssler, B, Burgio, K, Moore, K, Norton, P, Stanton, S (eds), Pelvic Floor Re-education, 2nd edn, pp. 190–95. London: Springer-Verlag; 2008.CrossRefGoogle Scholar
45Siegel, G, Richardson, D, Miller, Ket al.Pelvic floor electrical stimulation for the treatment of urge and mixed urinary incontinence in women. Urology 1997; 50: 934–40.CrossRefGoogle Scholar
46Richardson, D, Miller, K, Siegel, S, Karram, M, Blackwood, N, Staskin, D.Pelvic floor electrical stimulation: a comparison of daily and every other day therapy for genuine stress incontinence. Urology 1996; 48: 110–18.CrossRefGoogle ScholarPubMed
47Yamanishi, T, Yasuda, K, Sakakibara, R, Hattori, T, Ito, H, Murakami, S.Pelvic floor electrical stimulation in the treatment of stress incontinence: an investigational study and a placebo controlled double-blind trial. J Urol 1997; 158: 2127–31.CrossRefGoogle Scholar
48Luber, K, Wolde-Tsadik, G.Efficacy of functional electrical stimulation in treating genuine stress incontinence: a randomised controlled trial. J Neurourol Urodyn 1997; 16: 543–51.3.0.CO;2-E>CrossRefGoogle Scholar
49Brubaker, L, Benson, J, Bent, A, Clark, A, Shott, S.Transvaginal electrical stimulation for female urinary incontinence. Am J Obstet 1997; 177: 536–40.CrossRefGoogle ScholarPubMed
50Walsh, L, Johnstone, R, Keane, P.Transcutaneous sacral neurostimulation for irritative voiding dysfunction. Eur Urol 1999; 35: 192–96.CrossRefGoogle ScholarPubMed
51Hasan, S, Robson, W, Pridie, Aet al.Transcutaneous electrical nerve stimulation and temporary S3 neuromodulation in idiopathic detrusor instability. J Urol 1996; 155: 2005–11.CrossRefGoogle ScholarPubMed
52Soomro, N, Khadra, M, Robson, Wet al.A cross over randomised trial of transcutaneous electrical nerve stimulation and Oxybutinin in patients with detrusor instability. J Urol 2001; 166: 146–49.CrossRefGoogle Scholar
53Arya, L, Myers, D, Jackson, N.Dietary caffeine intake and the risk for detrusor instability: a case-control study. Obstet Gynecol 2000; 96: 8589.Google ScholarPubMed
54Tomlinson, B, Dougherty, M, Pendergast, Jet al.Dietary caffeine, fluid intake and urinary incontinence in older rural women. Int Urogynecol J 1999; 10: 2228.CrossRefGoogle ScholarPubMed
55Tampakoudis, P, Tantanassis, T, Grimbizis, Get al.Cigarette smoking and urinary incontinence in women: a new calculative method of estimating the exposure to smoke. Eur J Obstet Gynecol Reprod Biol 1995; 63: 2730.CrossRefGoogle Scholar
56Hannestad, Y, Rortveit, G, Daltveit, Aet al.Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG: Int J Obstet Gynecol 2003; 110: 247–54.CrossRefGoogle ScholarPubMed
57Asplund, R, Aberg, H.Nocturia in relation to body mass index, smoking and some other lifestyle factors in women. Climacteric 2004; 7: 267–73.CrossRefGoogle ScholarPubMed
58Roe, B, Doll, H.Lifestyle factors and continence status: comparison of self-report data from a postal survey in England. J Wound Ostomy Cont Nursing 1999; 26: 312–19.Google ScholarPubMed
59Subak, L, Whitcomb, E, Shen, Het al.Weight loss: a novel and effective treatment for urinary incontinence. J Urol 2005; 174: 190–95.CrossRefGoogle ScholarPubMed
60Wing, R, Creasman, J, Smith West, Det al.Improving urinary incontinence in overweight and obese women through modest weight loss. Obstet Gynaecol 2010; 116: 284–92.CrossRefGoogle ScholarPubMed
61Wing, R, Smith West, D, Grady, Det al.Effect of weight loss on urinary incontinence in overweight and obese women: results at 12 and 18 months. J Urol 2010; 184: 1005–10.CrossRefGoogle ScholarPubMed
62Spence-Jones, C, Kamm, M, Henry, Met al.Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynaecol 1994; 101: 147–52.CrossRefGoogle ScholarPubMed
63Griffiths, D, McCracken, P, Harrison, G, Gormley, E.Relationship of fluid intake to voluntary micturition and urinary incontinence in geriatric patients. J Neurourol Urodyn 1993; 12: 17.CrossRefGoogle Scholar
64Swithinbank, L, Hashim, H, Abrams, P.The effect of fluid intake on urinary symptoms in women. J Urol 2005; 174: 187–89.CrossRefGoogle ScholarPubMed
65O’Dell, K, McGee, S.Acupuncture for urinary urgency in women over 50: what is the evidence? Urologic Nursing 2006; 26: 2328.Google ScholarPubMed
66Bergström, K, Carlsson, C, Lindholm, C, Widengren, R.Improvement or urge- and mixed-type incontinence after acupuncture among elderly women – a pilot study. J Autonomic Nerv Syst 2000; 79: 173–80.CrossRefGoogle ScholarPubMed
67Engberg, S, Cohen, S, Sereika, S.Efficacy of acupuncture in treating urge and mixed incontinence in women. J Wound Ostomy Cont Nursing 2009; 36: 661–70.CrossRefGoogle ScholarPubMed
68Emmons, S, Otto, L.Acupuncture for overactive bladder. Obstet Gynecol 2005; 106: 138–43.CrossRefGoogle ScholarPubMed
69Freeman, R, Baxby, K.Hypnotherapy for incontinence caused by the unstable detrusor. Br Med J 1982; 284: 1831–34.CrossRefGoogle ScholarPubMed
70Barenberg, B, Abbasy, S, Michelfelder, A, FitzGerald, M. Hypnotherapy for lifelong incontinence. 31st Annual Scientific Meeting of the American Urogynecologic Society; 29 Sep–2 Oct 2010, Long Beach California; Conference Publication 16 (5), suppl 2: 146.Google Scholar
71Komesu, Y, Sapien, R, Rogers, R, Ketai, L.Hypnotherapy for treatment of overactive bladder: a randomised controlled trial pilot study. Female Pelvic Med Reconstruct Surg 2011; 17: 308–13.CrossRefGoogle Scholar
72Edwards, N, Jones, D.The prevalence of faecal incontinence in older people living at home. Age Ageing 2001; 30: 503–7.CrossRefGoogle ScholarPubMed
73Perrin, L, Wood Dauphinēe, S, Corcos, J, Hanley, J, Kuchel, G.Pelvic floor muscle training with biofeedback and bladder training in elderly women. J Wound Ostomy Cont Nursing 2005; 32: 186–99.CrossRefGoogle ScholarPubMed
74Tak, E, van Hespen, A, van Dommelen, P, Hopman-Rock, M.Does improved functional performance help to reduce urinary incontinence in institutionalised older women? A multicentre randomised clinical trial. Geriatrics 2012; 12: 5166.CrossRefGoogle Scholar
75, K, Kvarstein, B, Nygaard, I.Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years. Am Coll Obstet Gynecol 2005; 105: 9991005.CrossRefGoogle ScholarPubMed
76Shamliyan, T, Kane, R, Wyman, J, Wilt, T.Systematic review: randomised, controlled trials of non-surgical treatments for urinary incontinence in women. Annals Int Med 2008; 148: 459–74.CrossRefGoogle Scholar
77Burgio, K, Goode, P, Locher, J.Behavioural training with and without biofeedback in the treatment of urge incontinence in older women. J Am Med Assoc 2002; 288: 2293–99.CrossRefGoogle Scholar
78Milne, J.Behavioural therapies for overactive bladder: making sense of the evidence. J Wound Ostomy Cont Nursing 2008; 35: 93101.CrossRefGoogle Scholar
79Bourcier, A, McGuire, E, Abrams, P.Pelvic Floor Disorders. Philadelphia: Elsevier Inc; 2004.Google ScholarPubMed
80Tannenbaum, C, Perrin, L, DuBeau, C, Kuchel, G.Diagnosis and management of urinary incontinence in the older patient. Arch Physical Med Rehabil 2001; 82: 134–38.CrossRefGoogle ScholarPubMed
81Muller, N.What the future holds for continence care. Urologic Nursing 2004; 24: 181–86.Google ScholarPubMed