Dumoulin C, Adewuyi T, Booth J, Bradley C, Burgio K, Hagen S, Hunter K, Imamura M, Morin M, Morkved S, Thakar R, Wallace S, Williams K. Adult conservative management. In: Abrams P, Cardozo L, Wagg A, Wein A, ed. Incontinence: 6th International Consultation on Incontinence, Tokyo, September 2016. Bristol, UK: International Continence Society (ICS) and International Consultation on Urological Diseases (ICUD), 2017, pp.1443-1628. Copyright: Copyright © ICS 2017. This book chapter may be downloaded for personal use only. Any other use requires prior permission of the author and the publisher. URL link to article: https://www.ics.org/education/icspublications/icibooks/6thicibook Date deposited: 31/10/2017 Embargo release date: 01 November 2018 Newcastle University ePrints - eprint.ncl.ac.uk Committee 12 ADULT CONSERVATIVE MANAGEMENT Chair C. DUMOULIN (CANADA) Members T. ADEWUYI (UK) J. BOOTH (UK) C. BRADLEY (USA) K. BURGIO (USA) S. HAGEN (UK) K. HUNTER (CANADA) M. IMAMURA (UK) M. MORIN (CANADA) S. MORKVED (NORWAY) R. THAKAR (UK) S. WALLACE (UK) K. WILLIAMS (UK) The present chapter would not have been possible without the work of the previous editors, Katherine Moore [2013], Jean hay Smith [2008] and don Wilson [2000, 2004]. They produced the remarkable framework for the present review. In addition, we would like to acknowledge the indispensable contribution of Pauline Campbell to the reviewing, analysis and reporting of POP section. Finally, this chapter would not have been possible without the untiring dedication of Yvonne Ruella. 1 CONTENTS 3.2.2 Are VC As Effective as Other Treatments? 60 INTRODUCTION 6 3.2.3 Are VC Combined with PFMT Better than PFMT Alone? ............................................. 60 URINARY INCONTINENCE IN WOMEN 7 3.3. Other Lower Urinary Tract Symptoms 1. Lifestyle Modification Interventions .......... 7 (LUTS)......................................................... 61 1.1. Prevention ................................................... 8 3.4. Factors Affecting Outcome ....................... 61 1.2. Treatment ..................................................... 8 4. Electrical Stimulation (EStim) ................... 61 1.2.1 Weight Loss by Obese or Overweight 4.1. Prevention .................................................. 62 Women ......................................................... 8 4.2. Treatment ................................................... 68 1.2.2 Physical Activity ........................................ 10 4.2.1 Is EStim Better than No Active Treatment 1.2.3 Strenuous Physical Activity ..................... 10 (Placebo, Sham, Control or No Treatment) for Treatment of UI? .................................. 68 1.2.4 Smoking ..................................................... 10 4.2.2 Is One Type of EStim Better than Another 1.2.5 Dietary Modification (Elimination Diet) .... 11 in the Treatment of UI? .............................. 68 1.2.6 Constipation .............................................. 14 4.2.3 Is EStim Better than Other Treatments for 1.3. Other LUTS ................................................ 14 UI? .............................................................. 70 1.4. Factors Affecting Outcome ...................... 14 4.2.4 Does the Addition of EStim to Other Treatments Add Any Benefit in the 2. Pelvic Floor Muscle Training (PFMT) ....... 14 Treatment of UI? ........................................ 70 2.1. Prevention and Treatment (Pregnant and 4.3. Other LUTS ................................................ 72 Postnatal Women Only) ............................ 14 4.4. Factors Affecting Outcome ....................... 72 2.1.1 Is PFMT Effective in the Prevention of UI in Childbearing Women? .............................. 14 5. Posterior Tibial Nerve Stimulation (PTNS) .................................................................... 73 2.1.2 Is PFMT Effective in the Treatment of UI in Childbearing Women? .............................. 15 5.1. Prevention .................................................. 77 2.1.3 Is PFMT Effective in the Mixed Prevention 5.2. Treatment ................................................... 77 and Treatment of UI in Childbearing 5.2.1 Is PTNS Better than No Active Treatment Women? ..................................................... 16 (Placebo, Sham, Control or No Treatment) 2.2. Prevention (Other Women) ....................... 22 for Treatment of UI? .................................. 77 2.3. Treatment (Other Women) ........................ 22 5.2.2 Is One Type of PTNS Better than Another in the Treatment of UI? .................................. 77 2.3.1 Is PFMT Better than No Treatment, a Placebo, or a Control Group Treatment? 22 5.2.3 Is PTNS Better than Other Treatments for Treatment of UI? ........................................ 77 2.3.2 Is One Type of PFMT Programme Better than Another?............................................ 23 5.2.4 Does the Addition of PTNS to Other Treatments Add Any Benefit in the 2.3.3 Is PFMT Better than Other Treatments? .. 43 Treatment of UI? ........................................ 80 2.3.4 Does the Addition of PFMT to Other 5.3. Other LUTS ................................................ 82 Treatments Add Benefit? .......................... 48 5.4. Factors Affecting Outcome ....................... 82 3. Weighted Vaginal Cones (VC) .................. 52 6. Magnetic Stimulation (MStim)................... 82 3.1. Prevention ................................................. 52 6.1. Prevention .................................................. 83 3.2. Treatment ................................................... 52 6.2. Treatment ................................................... 83 3.2.1 Are VC Better than No Treatment, Placebo or Control Treatments? ............................ 60 6.2.1 Is MStim Better Than no Active Treatment (Placebo, Control or no Treatment)?........ 83 2 6.2.2 Is One Approach to MStim Better than 9.3.1 Lifestyle Modification Intervention ........... 97 Another? .................................................... 85 9.3.2 PFMT in Antenatal and Postnatal women 97 6.2.3 Is MStim Better than Other Treatments? . 85 9.3.3 PFMT in Women (Others) .......................... 97 6.2.4 Does the Addition of MStim to Other Treatments Add Any Benefit in the 9.3.4 Vaginal Cones ............................................ 98 Treatment of UI? ........................................ 85 9.3.5 EStim/PTNS/MStim .................................... 98 6.3. Other LUTS ................................................ 85 9.3.6 Scheduled Voiding Regimen .................... 98 6.4. Factors Affecting Outcome ...................... 85 7. Scheduled Voiding Regimens .................. 85 PELVIC ORGAN PROLAPSE (POP) 98 7.1. Prevention ................................................. 87 1. Lifestyle Modification Intervention ........... 98 7.2. Treatment ................................................... 87 1.1. Prevention .................................................. 98 7.2.1 What Is the Most Appropriate Bladder 1.1.1 Quality of Data ........................................... 98 Training (BT) Protocol? ............................ 87 1.1.1.1 Association Between POP and 7.2.2 Is BT Better than No Treatment, Placebo or Occupation and Physical Activity........ 98 Control Treatments? ................................. 89 1.1.1.2 Association Between POP and Body 7.2.3 Is BT Better than Other Treatments? ....... 89 Weight .................................................... 99 7.2.4 Can Any Other Treatment Be Added to BT 1.1.1.3 Association Between POP and Smoking to Add Benefit? ......................................... 90 ............................................................... 99 7.2.5 Does the Addition of BT to Other Treatment 1.1.1.4 Association Between POP and Bowel Add Benefit? .............................................. 90 Function .............................................. 105 7.2.6 Is Timed Voiding Effective at Treating UI? 1.1.1.5 Association Between POP and Nutrition 91 ............................................................. 105 7.3. Other LUTS ................................................ 91 1.1.2 Results ..................................................... 105 7.4. Factors Affecting Outcome ...................... 92 1.1.2.1 Association Between POP and Occupation and Physical Activity...... 105 8. Complementary and Alternative Medicines .................................................................... 92 1.1.2.2 Association Between POP and Body Weight .................................................. 106 8.1. Prevention ................................................. 93 1.1.2.3 Association Between POP and Smoking 8.2. Treatment ................................................... 93 ............................................................. 106 8.2.1 Acupuncture for Treatment of SUI ........... 93 1.1.2.4 Association Between POP and Bowel 8.2.2 Acupuncture for Treatment of OAB, UUI Function .............................................. 106 and Mixed UI .............................................. 93 1.1.2.5 Association Between POP and Nutrition 9. Future Research Directions ..................... 95 ............................................................. 107 9.1. Summary .................................................... 95 1.2. Treatment ................................................. 107 9.2. Recommendations for practice ................ 95 2. Pelvic Floor Muscle Training .................. 108 9.2.1 Lifestyle Intervention ...............................