Conservative management for urinary incontinence and pelvic organ prolapse

This review evaluated recent recommendations regarding first-line treatments for urinary incontinence and pelvic organ prolapse. Authors concluded that recent findings on conservative first-line treatment are promising, but more high-quality evidence is needed.

Urinary incontinence and pelvic organ prolapse are both associated with bothersome symptoms that affect quality of life and challenge everyday activities. There are a number of effective first-line approaches that do not involve drug therapy or surgery. The review of evidence was conducted in an effort to update recommendations for first-line treatment of urinary incontinent and pelvic organ prolapse.

A number of recent high-quality studies suggested that lifestyle changes can have a significant impact in treating and preventing urinary incontinence. Weight loss in overweight patients was recommended as a first-line treatment to reduce urinary incontinence, particularly when coupled with physical exercise. Reducing fluid intake (by about 25%) was also noted as associated with a decrease in urinary frequency and urgency, but not incontinence. Smoking, caffeine and high-caloric diets have previously been found to increase severity of urinary incontinence, however, high-quality evidence on these factors is still lacking.  

Pelvic-floor muscle training was recommended as a first treatment for stress incontinence (involuntary urine leakage during exertion, sneezing, coughing, lifting or any other physical activity), urge incontinence (involuntary urine leakage accompanied by a sudden and compelling desire to pass urine), and mixed incontinence (both stress and urge symptoms). Based on recent high-quality studies, pelvic-floor muscle training can be recommended for pregnant women to prevent or reduce urinary incontinence severity after childbirth, as well as for persistent urinary incontinence after childbirth. For increased therapeutic effectivity, pelvic-floor muscle training can be supervised by a health professional or combined with bladder training or vaginal cones. Evidence is mixed regarding the use of biofeedback (training to learn to control body functions which are normally involuntary) during pelvic-floor exercises.

Another early treatment for urinary incontinence includes electrical stimulation to stimulate weakened pelvic-floor muscles. Preliminary studies suggested a benefit of electrical stimulation over no treatment, however, some patients may experience discomfort with electrical stimulation.

For women with pelvic organ prolapse, certain lifestyle changes can reduce further strain on the prolapse. For example, there is increasing evidence that obesity and prolapse are directly linked. High-quality studies also noted that activities such as heavy lifting or hard physical labor play a role in the development and progression of prolapse. New evidence supports the effectiveness of physiotherapy in the treatment of pelvic organ prolapse. These include pelvic-floor muscle training, with or without prolapse repair surgery, as well as pessaries.

The authors concluded that there is increasing evidence to support the use of conservative first-line approaches in treating urinary incontinence and pelvic organ prolapse.