Female urinary incontinence: a systematic overview and non-surgical treatment

Cosette Ngarambe, Dan-hong Peng


Urinary Incontinence was acknowledged in 1998 by World Health Organization as a disease, to raise the awareness of the condition. Literature suggests that 50% of the incontinent women would be less than 50 years of age. Despite the great evolution in the area of gynecology, incontinence remains a real problem for number of women around the world. In some area the embarrassing nature of urinary incontinence has lead women to hide the existence of syndromes. Most of the women will seek health care at a late stage, when there is little or nothing to do. Alternative opportunity of surgery reveal to be a costly choice as popular believes that urinary incontinence is a fatality to all women. Little is known or rather little is provided to women in order to understand the process which causes urinary incontinence, whereas to the shame inflicted to them. This review paper aims to give a systematic overview of female urinary incontinence, and to a certain extent to present its non-surgical approach.


Urinary incontinence, Obstetric fistula, Non-surgical treatment, Pharmacotherapy

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Niang L, Kane R, Ndoye M, Jalloh M, Labou I, Diaw JJ, et al. Urinary incontinence in woman: Epidemiologic profile in Sub Saharian countries. Prog Urol. 2010;20(3):1213-6.

Hsieh CH, Su TH, Chang ST, Lin SH, Lee MC, Lee MY. Prevalence of and attitude toward urinary incontinence in postmenopausal women. Int J Gynaecol Obstet. 2008;100(2):171-4.

Rebassa M, Taltavull J, Gutiérrez C, Ripoll J, Esteva A, Miralles J, et al. Urinary incontinence in Mallorcan women: prevalence and quality of life. Actas Urol Esp. 2013;37(6):354-61.

Kinchen KS, Burgio K, Diokno AC, Fultz NH, Bump R, Obenchain R. Factors associated with women’s decisions to seek treatment for urinary incontinence. J Women’s Health (Larchmt). 2003;12(7):687-98.

Wang C, Li J, Wan X, Wang X, Kane RL, Wang K. Effects of stigma on Chinese women's attitudes towards seeking treatment for urinary incontinence. J Clin Nurs. 2015 Apr;24(7-8):1112-21.

Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213-40.

National Collaborating Centre for Women’s and Children’s Health. Urinary incontinence in women: the management of urinary incontinence in women. In: RCOG, eds. A Report. London, UK: The Royal College of Obstetricians and Gynaecologists; 2013: 1-385.

Andersson K-E, Chapple CR, Cardozo L, Cruz F, Hashim H, Michel MC, et al. Pharmacological treatment of urinary incontinence. In: Abrams P, Khoury S, Wein A, eds. Incontinence. 3rd International Consultation on Incontinence. Plymouth, UK: Plymouth, Plymbridge Distributors Ltd; 2005: 1-811.

Herbison P, Hay-Smith J, Ellis G, Moore K. Effectiveness of anticholinergic drugs compared with placebo in the treatment of overactive bladder: systematic review. Br Med J. 2003;326(7394):841-4.

Chapple CR, Martinez-Garcia R, Selvaggi L, Toozs-Hobson P, Warnack W, Drogendijk T, et al. A comparison of the efficacy and tolerability of solifenacin succinate and extended release tolterodine at treating overactive bladder syndrome: results of the STAR trial. Eur Urol. 2005;48(3):464-70.

Novara G, Galfano A, Secco S, D’Elia C, Cavalleri S, Ficarra V, et al. Systematic review and meta-analysis of randomized controlled trials with antimuscarinic drugs for overactive bladder. Eur Urol. 2008;54(4):740-63.

Schröder A, Abrams P, Andersson K-E, Artibani W, Chapple CR, Drake MJ, et al. Guideline on urinary incontinence. In: Schröder A, Abrams P, Andersson K-E, Artibani W, Chapple CR, Drake MJ, et al., eds. A Guideline. Europe: European Association of Urology; 2009: 1-52.

Carls C. The prevalence of stress urinary incontinence in high school and college-age female athletes in the midwest: implications for education and prevention. Urol Nurs. 2007;27(1):21-4, 39.

Kinchen KS, Lee J, Fireman B, Hunkeler E, Nehemiah JL, Curtice TG. The prevalence, burden, and treatment of urinary incontinence among women in a managed care plan. J Women’s Health (Larchmt). 2007;16(3):415-22.

Sampselle CM, Harlow SD, Skurnick J, Brubaker L, Bondarenko I. Urinary incontinence predictors and life impact in ethnically diverse perimenopausal women. Obstet Gynecol. 2002;100(6):1230-8.

Griffiths AN, Makam A, Edwards GJ. Should we actively screen for urinary and anal incontinence in the general gynaecology outpatients setting? - a prospective observational study. J Obstet Gynaecol. 2006;26(5):442-4.

Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD, Shekelle P. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American college of physicians. Ann Intern Med. 2014;161(6):429-40.

Parsons M, Cardozo L. The classification of urinary incontinence. Rev Gynaecol Pract. 2003;3(2):57-64.

Apell RA, Baum N. Evaluation of urinary incontinence in the elderly. J La State Med Soc. 1992;144:517-22.

Resnick NM, Ouslander JG. National institutes of health consensus development conference on urinary incontinence. J Am Geriatr Soc. 1990;38:263-86.

Resnick NM. Voiding dysfunction in the elderly. In: Yalla SV, McGuire EJ, Elbadawi A, Blaivas JG, eds. Neurology and Urodynamics: Principles and Practice. New York: Macmillan; 1988: 303-330.

Arlen AM, Dewhurst LL, Kirsch SS, Dingle AD, Scherz HC, Kirsch AJ. Phantom urinary incontinence in children with bladder-bowel dysfunction. Urology. 2014;84(3):685-8.

Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynecol Obstet. 2003;82(3):327-38.

Norton P, Brubaker L. Urinary incontinence in women. Lancet. 2006;367(9504):57-67.

Allen C, Kean D. Pathophysiology of urinary incontinence. Rev Gyneacol Pract. 2005;5(1):65-70.

Wood LN, Anger JT. Urinary incontinence in woman. BMJ. 2014;349:g4531.

Frullani Y. L’incontinence urinaire chez le sujet âgé. Actualités Pharmaceutiques. 2014;53(553):27-31.

Huebner M, Antolic A, Tunn R. The impact of pregnancy and vaginal delivery on urinary incontinence. Int J Gynecol Obstet. 2010;110(3):249-51.

Arrue M, Diez-Itza I, Ibañez L, Paredes J, Murgiondo A, Sarasqueta C. Factors involved in the persistence of stress urinary incontinence from pregnancy to 2 years post-partum. Int J Gynecol Obstet. 2011;115(3):256-9.

McKinnie V, Swift SE, Wang W, Woodman P, O’Boyle A, Kahn M, et al. The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. Am J Obstet Gynecol. 2005;193(2):512-7.

Lewicky-Gaupp C, Cao DC, Culbertson S. Urinary and anal incontinence in African American Teenaged Gravidas during Pregnancy and the Puerperium. J Pediatric Adolesc Gynecol. 2008;21(1):21-6.

Meyer S, Schreyer A, DeGrandi P, Hohfeld P. The effects of birth on urinary continence mechanisms and other pelvic-floor characteristics. Obstet Gynecol. 1998;92(4 Pt):613-8.

Goldberg RP, Kwon C, Gandhi S, Atkuru LV, Sorensen M, Sand PK. Urinary incontinence among mothers of multiples: the protective effect of cesarean delivery. Am J Obstet Gynecol. 2003;188(6):1447-53.

Wang JC, Yuan Miao, Liu GL, Feng H, Rong FN. Effects of pregnancy and childbirth on female pelvic support floor. J Shandong Univ (Health Sci). 2012;50(12):82-6.

Mallett VT, Brubaker L, Stoddard AM, Borello-France D, Tennstedt S, Hall L, et al. The expectations of patients who undergo surgery for stress incontinence. Am J Obstet Gynecol. 2008;198(3):308.e1-6.

Wesnes SL, Hunskaar S, Bo K, Rortveit G. Urinary incontinence and weight change during pregnancy and postpartum: a cohort study. Am J Epidemiol. 2010;172(9):1034-44.

Yang X, Zhang HX, Yu HY, Gao XL, Yang HX, Dong Y. The prevalence of fecal incontinence and urinary incontinence in primiparous postpartum Chinese women. Eur J Obstet Gynecol Reprod Biol. 2010;152(2):214-7.

Hernández RV, Aranda ER, Aznar CT. Urinary incontinence and weight changes during pregnancy and post-partum: a pending challenge. Midwifery. 2013;29(12)e123-9.

Mselle LT, Moland KM, Evjen-Olsen B, Mvungi A, Kohi TW. “I am nothing”: experiences of loss among women suffering from severe birth injuries in Tanzania. BMC Women’s Health. 2011;11:49.

Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula. Obstet Gynecol. 1988;72(3 Pt 1):313-9.

Eilber KS, Kavaler E, Rodriguez LV, Rosenblum N, Raz S. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169(3):1033-6.

Raassen TJIP, Verdaasdonk EGG, Vierhout ME. Prospective results after first-time surgery for obstetric fistulas in East African women. Int Urogynecol J. 2008;19:73-9.

Miller S, Lester F, Webster M, Cowan B. Obstetric fistula: a preventable tragedy. J Midwifery Women’s Health. 2005;50(4):286-94.

Wall LL. Obstetric vesicovaginal fistula as an international public-health problem. Lancet. 2006;368(9542):1201-9.

de Bernis L. Obstetric fistula: guiding principles for clinical management and programme development, a new WHO guideline. Int J Gynaecol Obstet. 2007;99(Suppl 1):S117-21.

Harrison KA. Obstetric fistula: one social calamity too many. Br J Obstet Gynaecol. 1983;90(5):385-6.

De Ridder D, Badlani GH, Browning A, Singh P, Sombie I, Wall LL. Fistulas in the developing world. In: Abrams P, Cardozo L, Khoury S, Wein A, eds. Incontinence. 4th ed. Paris: Health Publications; 2009: 1419-1458.

Brian Hancock. Obstetric fistulae: cause and nature; the obstetric fistula complex; classification. In: Andrew Bowning, eds. Practical Fistula Surgery. 1st ed. London, UK: Paula and David Bloomer; 2005: 1-13.

Wheeler II TL, Illston JD, Markland AD, Goode PS, Richter HE. Life space assessment in older women undergoing non-surgical treatment for urinary incontinence. Open J Obstet Gynecol. 2014;4(14):809-16.

Chapple CR, Manassero Francesca. Urinary incontinence in adults. Surg (Oxford) Renal Urogol. 2005;23(1):101-7.

Paul Abrams (Scientific Committee of the First International Consultation on Incontinence). Assessment and treatment of urinary incontinence. Lancet. 2000;355:2153-8.

Spence-Jones C, Kamm MA, Henry MM, Hudson CN. Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynaecol. 1994;101(2):147-52.

James JE, Sawczuk D, Merrett S. The effect of chronic caffeine consumption on urinary incontinence in psychogeriatric inpatients. Psychol Health. 1989;3(4):297-305.

Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG. 2003;110(3):247-54.

Eliasson K, Nordlander I, Larson B, Hammarström M, Mattson E. Influence of physical activity on urinary leakage in primiparous women. Scand J Med Sci Sports. 2005;15(2):87-94.

Ghaderi F, Oskouei AE. Physiotherapy for women with stress urinary incontinence: a review article. J Phys Ther Sci. 2014;26(9):1493-9.

Goode PS, Burgio KL, Johnson TM 2nd, Clay OJ, Roth DL, Markland AD, et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence. JAMA. 2011;305(2):151-9.

Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, et al. Randomized trial of percutaneous tibial nerve stimulation versus s efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183(4):1438-43.

Fujishiro T, Enomoto H, Ugawa Y, Takahashi S, Ueno S, Kitamura T. Magnetic stimulation of the sacral roots for the treatment of stress incontinence: an investigational study and placebo controlled trial. J Urol. 2000;164(4):1277-9.

Hasan ST, Robson WA, Pridie AK, Neal DE. Transcutaneous electrical nerve stimulation and temporary S3 neuromodulation in idiopathic detrusor instability. J Urol. 1996;155(6):2005-11.

Laycock J, Brown J, Cusack C, Green S, Jerwood D, Mann K, et al. Pelvic floor reeducation for stress incontinence: comparing three methods. Br J Community Nurs. 2001;6(5):230-7.

Wyman JF, Fantl JA, McClish DK, Bump RC. Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. Am J Obstet Gynecol. 1998;179(4):999-1007.

Zheng H, Sun Y, Xu Z, Hou M. Flow dynamics of urine in female patients with stress urinary incontinence treated by acupuncture and moxibustion. Int J Clin Acupuncture. 1992;3(3):243-7.

Wang LP, Wang LC, Shi GX, Zeng L, Yang Y, Zhang T, et al. Efficacy and safety of ginger-salt-indirect moxibustion for urge urinary incontinence after stroke: protocol for a pilot multicentre randomized controlled trial. BMJ Open. 2014;4:e006326.

Smith N, D’Hooghe V, Duffin S, Fitzsimmons D, Rippin C, Wilde G. Hypnotherapy for the unstable bladder: four case reports. Contemp Hypnosis. 1999;16(2):87-94.

Diment AD. Hypnosis in the treatment of urinary incontinence. Aust J Clin Exp Hypnosis. 1980;8(1):13-20.

Vinchurkar SA, Arankalle DV. Integrating Yoga therapy in the management of urinary incontinence: a case report. J Evid Based Complement Altern Med. 2014 Dec;24:pii: 2156587214563311.

Chen YH, Lin YN, Chen WC, Hsieh WT, Chen HY. Treatment of stress urinary incontinence by ginsenoside Rh2. Am J Chin Med. 2014;42(4):817-31.

Thyssen H, Bidmead J, Lose G, Møller Bek K, Dwyer P, Cardozo L. A new intravaginal device for stress incontinence in women. BJU Int. 2001;88(9):889-92.

Morris AR, Moore KH. The Contiform incontinence device - efficacy and patient acceptability. Int Urogynecol J. 2003;14(6):412-7.

Nielsen KK, Kromann-Andersen B, Jacobsen H, Nielsen EM, Nording J, Holm HH, et al. The urethral plug: A new treatment modality for genuine urinary stress incontinence in women. J Urol. 1990;144(5):1199-202.

Chapple CR, Van Kerrebroeck PE, Jünemann KP, Wang JT, Brodsky M. Comparison of fesoterodine and tolterodine in patients with overactive bladder. BJU Int. 2008;102(9):1128-32.

Shamliyan T, Wyman JF, Ramakrishnan R, Sainfort F, Kane RL. Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review. Ann Intern Med. 2012;156(12):861-74. W301-10.

Staskin DR, Dmochowski RR, Sand PK, Macdiarmid SA, Caramelli KE, Thomas E, et al. Efficacy and safety of oxybutynin chloride topical gel for overactive bladder: a randomised, double blind, placebo controlled, multicentre study. J Urol. 2009;181(4):1764-72.

Marschall-Kehrel D, Feustel C, Persson de Geeter C, Stehr M, Radmayr C, Sillén U, et al. Treatment with propiverine in children suffering from non-neurogenic overactive bladder and urinary incontinence: results of a randomized placebo-controlled phase 3 clinical trial. Eur Urol. 2009;55(3):729-36.

Lucas MG, Bosch RJ, Burkhard FC, Cruz F, Madden TB, Nambiark AK, et al. EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2012;62(6):1130-42.

Steers WD, Herschorn S, Kreder KJ, Moore K, Strohbehn K, Yalcin I, et al. Duloxetine compared with placebo for treating women with symptoms of overactive bladder. BJU Int. 2007;100(2):337-45.

Kessler TM, Studer UE, Burkhard FC. The effect of terazosin on functional bladder outlet obstruction in women: a pilot study. J Urol. 2006;176(4 Pt 1):1487-92.

Low BY, Liong ML, Yuen KH, Chee C, Leong WS, Chong WL, et al. Terazosin therapy for patients with female lower urinary tract symptoms: a randomized, double-blind, placebo controlled trial. J Urol. 2008;179(4):1461-9.

Sanford M. Mirabegron: a review of its use in patients with overactive bladder syndrome. Drugs. 2013;73(11):1213-25.

Caremel R, Loutochin O, Corcos J. What do we know and not know about mirabegron, a novel b3 agonist, in the treatment of overactive bladder? Int Urogynecol J. 2014;24(2):165-70.

Tincello DG, Kenyon S, Abrams KR, Mayne C, Toozs-Hobson P, Taylor D, et al. Botulinum toxin a versus placebo for refractory detrusor overactivity in women: a randomised blinded placebo-controlled trial of 240 women (the RELAX study). Eur Urol. 2012; 62(3):507-14.

Cui Y, Wang L, Liu L, Zeng F, Niu J, Qi L, et al. Botulinum toxin-A injections for idiopathic overactive bladder: a systematic review and meta-analysis. Urol Int. 2013;91(4):429-38.

Anderson RU. Safety and efficacy of botulinumA toxin (BotoxA) for treatment of neurogenic bladder of Parkinson’s disease. Clinical Trials, 2011. [Identifier: NCT01421719]. Available at:

Clinical Trials. Allergan long term follow-up study of safety and efficacy of botulinum toxin type A for the treatment of patients with idiopathic overactive bladder with urinary incontinence. Clinical Trialsm 2012 [Identifier: NCT00915525]. Available at:

Andersson KE, Chapple CR, Cardozo L, Cruz F, Hashim H, Michel MC, et al. Pharmacological treatment of urinary incontinence. ICS guidelines 2009. In: 4th international consultation on incontinence. Curr Opin Urol. 2009;19(4):380-94.

Salmon UL, Walter RI, Gast SH. The use of oestrogen in the treatment of dysuria and incontinence in postmenopausal women. Am J Obstet Gynaecol. 1941;14:23-31.

Sultana CJ, Walters MD. Oestrogen and urinary incontinence in women. Maturitas. 1995;20:129-38.

Norgaard JP, Rillig S, Djurhuus JC. Nocturnal enuresis: an approach to treatment based on pathogenesis. J Pediatr. 1989;114(4 Pt 2):705-9.

Lose G, Lalos O, Freeman RM, van Kerrebroeck P; Nocturia Study Group. Efficacy of desmopressin in the treatment of nocturia: a double blind placebo controlled study in women. Am J Obstet Gynecol. 2003;189(4):1106-13.

Robinson D, Cardozo L, Akeson M, Hvistendahl G, Riis A, Norgaard J. Women take control; Desmopressin - a drug for daytime urinary incontinence. Neurourol Urodyn. 2002;21(4):385-6.

McGrother CW, Shaw C, Perry SI, Dallosso SM, Mensah FK. Epidemilogy (Europe). In: Cardozo L, Staskin D eds. Textbook of Female Urology and Urogynaecology. 3rd ed. Oxford: Isis Medical Media; 2001: 21-35.

Tran C, Damaser MS. The potential role of stem cells in the treatment of urinary incontinence. Ther Adv Urol. 2015;7(1):22-40.

Gnecchi M, Zhang Z, Ni A, Dzau V. Paracrine mechanisms in adult stem cell signaling and therapy. Circ Res. 2008;103(11):1204-19.

Carr L, Robert M, Kultgen P, Herschorn S, Birch C, Murphy M, et al. Autologous muscle derived cell therapy for stress urinary incontinence: a prospective, dose ranging study. J Urol. 2013;189(2):595-601.

Cruz M, Dissaranan C, Cotleur A, Kiedrowski M, Penn M, Damaser M. Pelvic organ distribution of mesenchymal stem cells injected intravenously after simulated childbirth injury in female rats. Obstet Gynecol Int. 2012;2012:612946.

Kuismanen K, Sartoneva R, Haimi S, Mannerström B, Tomás E, Miettinen S, et al. Autologous adipose stem cells in treatment of female stress urinary incontinence: results of a pilot study. Stem Cells Transl Med. 2014;3(8):936-41.

Goldman H, Sievert K, Damaser M. Will we ever use stem cells for the treatment of SUI? - ICI-RS 2011. Neurourol Urodyn. 2012;31(3):386-9.

Liu G, Deng C, Zhang Y. Urine derived stem cells: biological characterization and potential clinical applications. In: Turksen K, eds. Stem Cells: Current Challenges and New Directions. 11th ed. New York: Springer; 2013.