Abstract
BackgroundIncontinence constitutes a major health problem affecting millions of people worldwide. The present study aims to assess cure rates from treating urinary (UI) or fecal incontinence (FI) and the number of people who may remain dependent on containment strategies.MethodsMedline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and PEDro were searched from January 2005 to June 2015. Supplementary searches included conference abstracts and trials registers (2013–2015). Included studies had patients ≥ 18 years with UI or FI, reported treatment cure or success rates, had ≥ 50 patients treated with any intervention recognized in international guideline algorithms, a follow-up ≥ 3 months, and were published from 2005 onwards. Title and abstract screening, full paper screening, data extraction and risk-of-bias assessment were performed independently by two reviewers. Disagreements were resolved through discussion or referral to a third reviewer where necessary. A narrative summary of included studies is presented.ResultsMost evidence was found for UI: Surgical interventions for stress UI showed a median cure rate of 82.3% (interquartile range (IQR), 72–89.5%); people with urgency UI were mostly treated using medications (median cure rate for antimuscarinics = 49%; IQR, 35.6–58%). Pelvic floor muscle training and bulking agents showed lower cure rates for UI. Sacral neuromodulation for FI had a median cure rate of 38.6% (IQR, 35.6–40.6%).ConclusionsMany individuals were not cured and hence may continue to rely on containment. No studies were found assessing success of containment strategies. There was a lack of data in the disabled and in those with neurological diseases, in the elderly and those with cognitive impairment. Surgical interventions were effective for stress UI. Other interventions for UI and FI showed lower cure rates. Many individuals are likely to be reliant on containment strategies.PROSPERO RegistrationPROSPERO registration number: CRD42015023763.
Highlights
Incontinence constitutes a major health problem affecting millions of people worldwide
The most common reason for exclusion was that the treatment was not deemed ‘according to the ICI algorithms’ (603 records excluded); often because the intervention was a second or third line treatment and there was no description of previous interventions in first or second line
In the text below, pooled results for each intervention are reported as specified in the Methods section
Summary
Incontinence constitutes a major health problem affecting millions of people worldwide. Incontinence has a profound impact on well-being and quality of life, causing social embarrassment, reduced employment and work productivity, and preventing many people from participating in paid or unpaid activities [5, 10, 11]. It has a negative influence on sexual health [11,12,13]. Incontinence presents a significant health and economic burden comparable with common major diseases such as arthritis and pneumonia [14,15,16,17]
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