Urinary incontinence. Non-surgical management by family physicians.

OBJECTIVE: To review current evidence on conservative management of urinary incontinence (UI) by family physicians. QUALITY OF EVIDENCE: Articles were sought through MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CINAHL, PsycLit, ERIC, two consensus meetings, and review of abstracts presented at urology meetings. References of these articles were searched for relevant trials. Strong evidence supports bladder training, pelvic floor exercises, and some medications, but only fair evidence supports fluid adjustment, caffeine reduction, and stopping smoking. Weight loss and exercise are supported by expert opinion only. Consensus opinion is that, whenever possible, conservative management should be considered first. MAIN MESSAGE: Good evidence shows that initial management by primary care physicians is effective. After basic assessment and tests, strategies such as bladder retraining, pelvic floor exercises, and lifestyle modifications, augmented by appropriate medications, can be successful. If initial strategies are unsuccessful, patients can be referred. CONCLUSION: More than a million Canadians suffer from UI. In almost all cases, family physicians are the first health professionals contacted by patients. Basic assessment and conservative management can go far to ameliorate the problem.