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Physiotherapy for women with urinary incontinence is highly clinically effective and cost effective. 

What is urinary incontinence?

Urinary Incontinence (UI) is ‘the complaint of any involuntary loss of urine’. The most common form is stress UI, which is loss of urine on effort or physical exertion (e.g. sporting activities) or on coughing or sneezing.(1)

UI is distressing and socially disruptive. It may be the cause of personal health and hygiene problems. It may restrict employment and educational or leisure opportunities.(2) UI substantially increases the risk of hospitalization and admission to a nursing home.(3) It is widely understood that UI is a sensitive health issue and many women delay treatment for many years due to embarrassment or shame. Women may believe that UI is inevitable after childbirth or with advancing age and may not be aware of treatment options.(4)

Physiotherapy is clinically effective

  • Training and strengthening the pelvic floor muscles (the muscles that support the bladder and urethra) is recommended as first-line management for women with stress, urge or a mixture of stress and urge urinary incontinence.(2)
  • It is also recommended that it should be offered to women in their first pregnancy as a preventive strategy for UI.
  • Physiotherapists give advice,(5) to women with UI, on key public health messages that improve lifestyle and wellbeing including; weight loss, reduction of caffeine/fluid intake, cessation of smoking and an increase in physical exercise.

23% said UI reduced their activity levels.

Physiotherapy is cost effective

A recent health technology assessment reviewed the clinical evidence and modelled several non-surgical strategies. The results showed that more intensive pelvic floor muscle training, for example by delivering extra sessions (more than two per month), plus lifestyle changes was the most clinical and cost effective first-line strategy.(6) Physiotherapy may reduce the need for more complex or costly interventions. Studies show it has been found effective for up to five years for older women with urinary incontinence.(7)(8)

One study evaluated the clinical effectiveness and costs of physiotherapy sessions in a group compared with the same sessions delivered to individuals. The group sessions had comparable health outcomes and notably lower costs ($10 CDN compared to ~$106 CDN).(9)

Size of the problem

  • 10% or 3.3 million Canadians experience incontinence.(11) More women than men experience this condition; one estimate suggests that 7% of Canadian women experience some form of moderate to severe incontinence on a daily basis.(10)
  • Incontinence can limit physical activity, the ability to work, and participation in social activities.(11)
  • 1 in 8 Canadians 65 years or older experience incontinence.(11)
  • Older seniors with UI may experience loss of independence, increased personal expenses and reduced social interaction, resulting in social isolation.(12)
  • Only 26% of Canadians experiencing incontinence have consulted a doctor or health-care professional.(11)

Cost of Urinary Incontinence

  • Direct health costs for treatment of urinary incontinence is over $3.8 billion annually.(10)
  • Indirect costs, including lost work days and productivity is $2.59 billion.(10)
  • Out of pocket expenses for individuals experiencing incontinence range from $1,400 to $2,100 annually.(10)

Conclusion

Contact with a physiotherapist offers both recommended first-line treatment for UI and health promotion and prevention strategies, and has been proven to be both clinically and cost effective.

References

  1. 1. Haylen B, de Ridder D, Freeman R, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4-20.
  2. National Institute for Health and Clinical Excellence. Urinary incontinence: the management of urinary incontinence in women. CG171. London: National Institute for Health and Clinical Excellence; 2013. URL: http://guidance.nice.org.uk/CG171
  3. Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age Ageing. 1997;26(5):367-7. URL: http://ageing.oxfordjournals.org/content/26/5/367.long
  4. Shaw C BR, Allan R, Jackson C, Hyde C,. Barriers to help - seeking in people with urinary problems Family Practitioner. 2001;18(48-52) URL: http://fampra.oxfordjournals.org/content/18/1/48.short
  5. Boyle R, Hay-Smith EJC, Cody June D, et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. 2012(10) URL: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007471.pub2/abstract
  6. Imamura M, Abrams P, Bain C, et al. Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technol Assess. 2010 Aug;14(40):1-188, iii-iv. URL: http://www.journalslibrary.nihr.ac.uk/hta/volume-12/issue-26
  7. Dumoulin, C,  Hay-Smith J, Pelvic Floor Muscle Training  versus no treatment, or inactive control treatment for urinary incontinence in women( Review), Copyright (c) 2010 Cochrane Collaboration, published by John Wiley & Sons Ltd.
  8. Simard, C. Tu, L.A. Long Term Efficacy of Pelvic Floor Muscle Rehabilitation for Older Women with Urinary Incontinence J Obstet Gynaecol Can 2010;32(12):1163-1166
  9. Lamb S, Pepper J, Lall R, et al. Group treatments for sensitive health care problems: a randomised controlled trial of group versus individual physiotherapy sessions for female urinary incontinence. BMC Womens Health. 2009;9:26. URL: http://www.biomedcentral.com/1472-6874/9/26
  10. The Canadian Continence Foundation, The Impact of Incontinence in Canada: a briefing document for policy makers, 2014.
  11. The Canadian Continence Foundation, Incontinence: the Canadian Perspective,2014
  12. Ramage-Morin P., Gilmour H. Urinary Incontinence and Loneliness in Canadian Seniors,2013, Statistics Canada Catalogue no 82-003-X.

​Acknowledgement

Adapted and used with permission of the Chartered Society of Physiotherapy.