What are the causes and treatments of urinary incontinence (loss of bladder control)?

From the Guidelines

Urinary incontinence should be managed with nonpharmacologic therapies, such as pelvic floor muscle training, bladder training, and weight loss, as they have been shown to be effective in achieving continence and improving symptoms with a low risk of adverse effects. According to the American College of Physicians guideline 1, nonpharmacologic therapies had a large magnitude of benefit for increasing continence rates and were associated with a low risk for adverse effects. The guideline also states that pelvic floor muscle training alone and in combination with bladder training or biofeedback and weight loss with exercise for obese women were effective at achieving continence and improving urinary incontinence.

Some key points to consider in the management of urinary incontinence include:

• Pelvic floor muscle training should be performed 3 sets of 10 contractions daily, holding each contraction for 10 seconds
• Bladder training techniques can help improve symptoms of urge incontinence
• Weight loss can improve urinary incontinence symptoms in women who are obese
• Lifestyle modifications, such as limiting caffeine and alcohol intake, maintaining a healthy weight, avoiding constipation, and establishing a regular urination schedule, are essential for all types of incontinence

Pharmacologic therapies, such as solifenacin, tolterodine, and oxybutynin, may also be effective in managing urinary incontinence, but they are associated with a higher risk of adverse effects compared to nonpharmacologic therapies 1. A more recent study published in 2018 1 also highlights the effectiveness of weight loss and pelvic floor muscle training in improving urinary incontinence symptoms, and notes that medications may have a low magnitude of effect in improving continence. Overall, nonpharmacologic therapies should be considered as the first line of treatment for urinary incontinence, with pharmacologic therapies reserved for patients who do not respond to nonpharmacologic therapies or who have more severe symptoms.

From the FDA Drug Label

1.1 Adult Overactive Bladder (OAB) 5.2 Urinary Retention in Patients with Bladder Outlet Obstruction and in Patients Taking Muscarinic Antagonist Medications for OAB Mirabegron is used to treat overactive bladder (OAB), which can cause symptoms such as urinary incontinence.

• The drug label does not directly address the question of whether mirabegron causes urinary incontinence, but rather it is used to treat the condition.
• Urinary retention is a potential risk in certain patients, but this is not the same as urinary incontinence. 2

From the Research

Types of Urinary Incontinence

• Stress urinary incontinence: occurs when physical movement or pressure on the bladder causes involuntary loss of urine 3, 4, 5, 6
• Urge urinary incontinence: characterized by a sudden, intense need to urinate, often resulting in involuntary loss of urine 3, 4, 5, 6
• Mixed urinary incontinence: a combination of stress and urge urinary incontinence 3, 4, 5, 6
• Other types of urinary incontinence: may include overflow incontinence, functional incontinence, and transient incontinence 3

Diagnosis and Evaluation

• A thorough history and physical examination are essential for determining the type of urinary incontinence 3, 4, 5, 6
• Additional tests, such as urodynamic studies, may be necessary to guide diagnosis and treatment 4, 6

Treatment Options

• Lifestyle and behavioral modifications: including pelvic floor exercises, bladder training, and dietary changes 3, 4, 7, 6
• Medications: such as anticholinergics and alpha-blockers, may be used to treat urge urinary incontinence and overactive bladder 3, 4, 6
• Surgical options: including midurethral slings, artificial urinary sphincters, and male urethral slings, may be considered for stress urinary incontinence and other types of incontinence 4, 5, 6
• Alternative therapies: such as sacral neuromodulation, intravesical onabotulinumtoxinA injections, and posterior tibial nerve stimulation, may be used for select patient populations 6

Management of Urinary Incontinence in Specific Populations

• Men with urinary incontinence after prostate treatment: may require specialized management, including pelvic floor therapy and surgical options such as artificial urinary sphincters and male urethral slings 5
• Women with urinary incontinence: may benefit from pelvic floor exercises, bladder training, and lifestyle modifications, as well as surgical options such as midurethral slings 7, 6