The American College of Physicians (ACP) recommends Kegel exercises, bladder training, and weight loss and exercise as the preferred nonsurgical treatment options for women with urinary incontinence (UI), according to new evidence-based clinical practice guidelines published in Annals of Internal Medicine (2014;161[6]:429-440).

Amir Qaseem, MD, PhD, MHA, and ACP coauthors encouraged primary-care providers to take a detailed history and ask specific questions about UI, such as time of onset, symptoms, and frequency, as UI is an underreported and underdiagnosed condition. Qaseem and team noted that UI affects approximately 25% of women aged 14 years to 21 years, 44% to 57% of women aged 40 years to 60 years, and 75% of women aged 75 years and older.

The guideline recommends that women with stress UI (the inability to retain urine when laughing, coughing, or sneezing) use pelvic-floor muscle training (or Kegel exercises), rather than systemic drug therapy, to improve their symptoms. Women with urgency UI (the loss of urine for no apparent reason after suddenly feeling the need or urge to urinate) should undergo bladder training. If that is unsuccessful, medication should be considered.

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For mixed UI, which involves characteristics of both stress and urgency UI, Kegel exercises should be combined with bladder training. For obese women with UI, the ACP recommends weight loss and exercise.

The authors emphasized the importance of identifying and managing conditions that may cause UI, such as urinary tract infections, metabolic disorder, or excess fluid intake. Clinicians also should determine whether patients are taking medications that may cause or worsen UI.