Evidence and Consensus About Prevention of Fecal and Urinary Incontinence

Among the conclusions of an NIH panel: Behavioral changes to avoid obesity, increase physical activity, improve diet, and stop smoking can lower risk for incontinence.
A National Institutes of Health panel has issued a state-of-the-science statement on the prevention of fecal and urinary incontinence. The panel’s conclusions were based on a systematic evidence review, presentations by investigators, and discussion during a public session.
The panel concluded the following:

• Behavioral changes aimed at avoiding obesity, increasing physical activity, improving diet, and smoking cessation can lower risk for incontinence.
• Pelvic-floor muscle training and biofeedback can prevent and reverse pregnancy-related fecal and urinary incontinence in the first year after delivery and might prevent urinary incontinence in older women and in men who have undergone prostate surgery.
• Effective management of comorbid conditions (diabetes, irritable bowel syndrome, inflammatory bowel disease, neurologic conditions, impaired mobility, depression, diarrhea, constipation, and urgency) can allay development of incontinence.
• Avoidance of routine episiotomy during labor can prevent fecal incontinence.

A systematic review, commissioned as background for the conference, also showed that anticholinergic drugs (e.g., oxybutynin and tolterodine [Detrol]) could resolve urinary incontinence (18% more resolution than with placebo) and that duloxetine (Cymbalta) improved (but did not resolve) urinary incontinence. Pelvic-floor muscle and bladder training was effective for resolving urinary incontinence (13% more resolution compared with no training).
Comment: Because treatment of fecal and urinary incontinence generally is unsatisfactory, prevention is important. But, given that even the best preventive efforts will not eliminate these conditions, more-effective pharmacologic and nonpharmacologic treatments should be developed.
— Richard Saitz, MD, MPH, FACP, FASAM
Published in Journal Watch General Medicine April 24, 2008

Citation(s):

Landefeld CS et al. National Institutes of Health state-of-the-science conference statement: Prevention of fecal and urinary incontinence in adults. Ann Intern Med 2008 Mar 18; 148:449.