Can incontinence be cured? A systematic review of cure rates

Abstract

BackgroundIncontinence constitutes a major health problem affecting millions of people worldwide. The present study aims to assess cure rates from treating urinary (UI) or fecal incontinence (FI) and the number of people who may remain dependent on containment strategies.MethodsMedline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and PEDro were searched from January 2005 to June 2015. Supplementary searches included conference abstracts and trials registers (2013–2015). Included studies had patients ≥ 18 years with UI or FI, reported treatment cure or success rates, had ≥ 50 patients treated with any intervention recognized in international guideline algorithms, a follow-up ≥ 3 months, and were published from 2005 onwards. Title and abstract screening, full paper screening, data extraction and risk-of-bias assessment were performed independently by two reviewers. Disagreements were resolved through discussion or referral to a third reviewer where necessary. A narrative summary of included studies is presented.ResultsMost evidence was found for UI: Surgical interventions for stress UI showed a median cure rate of 82.3% (interquartile range (IQR), 72–89.5%); people with urgency UI were mostly treated using medications (median cure rate for antimuscarinics = 49%; IQR, 35.6–58%). Pelvic floor muscle training and bulking agents showed lower cure rates for UI. Sacral neuromodulation for FI had a median cure rate of 38.6% (IQR, 35.6–40.6%).ConclusionsMany individuals were not cured and hence may continue to rely on containment. No studies were found assessing success of containment strategies. There was a lack of data in the disabled and in those with neurological diseases, in the elderly and those with cognitive impairment. Surgical interventions were effective for stress UI. Other interventions for UI and FI showed lower cure rates. Many individuals are likely to be reliant on containment strategies.PROSPERO RegistrationPROSPERO registration number: CRD42015023763.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0828-2) contains supplementary material, which is available to authorized users.

Do brain structural abnormalities differentiate separate forms of urgency urinary incontinence?

“…Urgency urinary incontinence (UUI) is a common and troublesome problem. Despite decades of research its cause is not well understood and it remains difficult to treat . We have shown that neither ultrastructural nor urodynamic changes adequately explain the causal mechanism of UUI or its response to behavioral therapy.…”

“…We have shown that neither ultrastructural nor urodynamic changes adequately explain the causal mechanism of UUI or its response to behavioral therapy. Others have focused on peripheral abnormalities, but none of these approaches has identified a cause of UUI or greatly improved treatment …”

24/7 usage of continence pads and quality of life impairment in women with urinary incontinence

“…Nonetheless, median cure rate after medical interventions for SUI and urgency UI is 82.3% and 49% respectively. Therefore, many patients are not cured and rely on continence products …”

Approach to Urinary Incontinence in the Elderly in Primary Care: a Mini Review

“…Although urinary incontinence (UI) is seen 1.5-2 times more in women up to 80 years and after that age it is observed in both sexes in similar rate 5 Urinary incontinence is an important problem that leads to hygiene loss, pressure sores, sleep disturbance, sexual dysfunction, depression, social isolation, increased risk of fracture, impaired quality of life, and increase in the risk of being placed in a nursing home. 6,7 Many patients limit their social activity and this causes them to go away from their environment.…”

“…These are transient causes reminiscent with the initials of Delirium, infection, atrophic vaginitis, pharmaceutical, psychological, excess fluids, restricted mobility, stool impaction initials. 5 If incontinence persists after these transient causes have been ruled out and conditions have been improved, permanent causes should come to mind. The types of incontinence caused by these persistent causes include functional continence, stress incontinence, urge incontinence, mixed and overflow incontinence.…”