Hypothesis / aims of study
The aim of this clinical practice guideline (CPG) is to provide evidence-based recommendations for rehabilitation interventions of urgency urinary incontinence (UUI), urinary urgency, or urinary frequency in adult women.
Study design, materials and methods
Literature Search Databases utilized were OVID Medline, EMBASE, Cochrane Library, CINAHL, and ProQuest. The initial search was performed in October 2016 and was limited to articles published after January 1, 1995; this yielded 17,0006 titles. An updated search was conducted in June 2017 using a filter to exclude studies that focused on interventions for SUI due to the volume of references generated by the initial search. This search narrowed the number of articles to 2,161. Following the completion of data extraction and during the writing phase of this CPG in 2022, a final literature search was completed to ensure no new evidence had emerged between 2017 and 2022 that contradicted recommendations put forth by this CPG for the treatment of UUI, urinary urgency, and/or urinary frequency.
Results
Thirty-one articles [1-31] informed the development of seven of the recommendations for the intervention of urgency urinary incontinence, urinary urgency and / or urinary frequency. Two additional recommendations for best practice are presented as expert opinion with support of current literature [32-41].
Recommendations
Behavioral interventions:
● Evidence Quality: II
● Grade of recommendation: A
● Healthcare providers must prescribe behavioral interventions including bladder retraining, dietary & fluid modification, and urge suppression techniques for symptoms of urgency urinary incontinence, urinary urgency, and / or urinary frequency.
Pelvic floor muscle training:
● Evidence Quality: I
● Grade of recommendation: A
● Healthcare providers should prescribe pelvic floor muscle training programs when contraction quality has been confirmed for symptoms of urgency urinary incontinence, urinary urgency, and / or urinary frequency.
Transcutaneous tibial nerve neuromodulation:
● Evidence Quality: II
● Grade of recommendation: B
● Healthcare providers should use low frequency transcutaneous tibial nerve electrical stimulation for symptoms of urgency urinary incontinence, urinary urgency and / or urinary frequency in the absence of contraindications for electrical stimulation.
Transvaginal neuromodulation:
● Evidence Quality: II
● Grade of recommendation: B
● Healthcare providers should consider low frequency transvaginal electrical stimulation for symptoms of urgency urinary incontinence, urinary urgency and / or urinary frequency in the absence of contraindications for electrical stimulation.
Medication:
● Evidence Quality: I
● Grade of recommendation: B
● Healthcare providers who prescribe medications for urgency urinary incontinence, urinary urgency and / or urinary frequency should inform patients of the improved outcome when combined with pelvic health rehabilitation.
Weight loss:
● Evidence Quality: II
● Grade of recommendation: B
● Patients and healthcare providers should consider weight loss to reduce symptoms of urgency urinary incontinence, urinary urgency and / or urinary frequency in those with a body mass index (BMI) > 25 kg/m2.
Mindfulness-based stress reduction (MBSR):
● Evidence Quality: IV
● Grade of recommendation: C
● Patients and healthcare providers may consider use of mindfulness-based stress reduction to reduce symptoms of urgency urinary incontinence, urinary urgency and / or urinary frequency.
Constipation management:
● Evidence Quality: V
● Grade of recommendation: P (Best Practice)
● Patients and healthcare providers should address constipation to reduce symptoms of urgency urinary incontinence, urinary urgency and / or urinary frequency.
Fall risk management:
● Evidence Quality: V
● Grade of recommendation: P (Best Practice)
● Healthcare providers should address fall risk management for patients with urgency urinary incontinence, urinary urgency and / or urinary frequency.
Interpretation of results
The CPG offers guidance to healthcare providers and patients for the treatment of urinary urge incontinence, urinary urgency, and urinary frequency. Recommendations, in order of strength of evidence, include behavioral interventions and pelvic floor muscle training (Grade A) followed by electrical stimulation (Grade B), and then lifestyle modifications (Grades B and C). Healthcare practitioners that can prescribe medication for the treatment of UUI and urinary urgency / urinary frequency should inform patients of the improved outcome when combined with pelvic health rehabilitation. In the opinion of the CPG authors, health care providers should address constipation and fall risk when evaluating patients with UUI and urinary urgency/urinary frequency. It is our recommendation that future research focus on differentiation between various forms of behavioral interventions commonly used to treat UUI, the relationship between constipation and UUI as well as the causal relationship between UUI and fall risk, and assessment and treatment of overactive pelvic floor muscles as it relates to UUI.