Best Strategies for Urinary and Fecal incontinence

Complete Review Annals of Internal Medicine

The best approaches to treating and preventing adult incontinence are the subject of two articles released early by Annals of Internal Medicine.

One article, an examination of published evidence concerning nonsurgical treatment of urinary incontinence in women, reaches the following conclusions:

Pelvic floor muscle training would resolve 490 cases of stress incontinence per 1000 cases treated.
Oral hormonal therapy increased rates of incontinence, and estrogens administered transdermally or vaginally produced inconsistent improvements.
Oxybutynin and tolterodine increased continence rates, but duloxetine was not better than placebo.
Adrenergic drugs (clenbuterol, norepinephrine, and phenylpropanolamine) were not effective.
The other article, a "state-of-the-science" statement on adult incontinence from an NIH-sponsored conference, concludes:

"Routine episiotomy is the most easily preventable risk factor for fecal incontinence."
Pelvic floor muscle training may "prevent or reduce urinary incontinence in older women and in men undergoing prostate surgery," while lifestyle changes, such as weight loss and exercise, may prevent both urinary and fecal incontinence