Treating urinary incontinence in the elderly--conservative therapies that work: a systematic review.

OBJECTIVE: To evaluate the effectiveness of conservative treatment in the community-based elderly (aged > or = 55 years) with stress, urge, and mixed urinary incontinence. DESIGN: Systematic review of before-after studies or randomized controlled trials on the effect of exercise and drug therapy in urinary incontinence. MAIN OUTCOMES MEASURED: Reduction of urinary accidents, patient's perception, cystometric measurement, perineometry, and side effects. SEARCH STRATEGY: MEDLINE (1966-2001), EMBASE (1986-2001), Science Citation Index (1988-2001), The Cochrane Library, and PiCarta were searched. RESULTS Four before-after studies and 4 randomized controlled trials were identified. Drug therapy alone: no study of sufficient quality. Drug therapy compared with behavioral therapy, 3 studies: bladder-sphincter biofeedback reduced urinary accidents in cases of urge or mixed incontinence by 80.7%, significantly better than oxybutynin (68.5%) or placebo (39.4%). Adding drug to behavioral treatment or behavioral to drug treatment also resulted in significant reduction in urodynamic urge incontinence (57.5%-88.5% vs 72.7-84.3%). Pelvic floor exercises alone reduced urinary accidents by 48% (compared with 53% for phenylpropanolamine) in patients with mixed or stress incontinence. Behavioral therapy, 5 studies: bladder-sphincter biofeedback in case of urge or mixed incontinence, bladder training in case of urge incontinence and pelvic floor exercises in case of stress incontinence reduced the urinary accidents with 68% to 94%. CONCLUSION: There are only a few studies of sufficient methodological quality on the effect of conservative treatment of urinary incontinence in the elderly. Behavioral therapy reduced urinary accidents; the effect of drug therapy is unclear. We recommend behavioral therapy as first choice