Diagnose1 by hx/PE:

¹ Stress UI is related to urethral sphincter failure associated w/ intra-abdominal pressure resulting in inability to retain urine while laughing/coughing/sneezing. Distinction between stress and urgency UI not always clear, esp in older women.<br><br>² Nonpharmacologic tx is better than no tx, has large magnitude of effect, and is associated w/ low risk for adverse effects.
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³ PFMT definition: instruction of voluntary pelvic floor muscle contraction (Kegel exercises).
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⁴ PFMT increases continence rates in pts w/ stress UI vs no tx (NNT=3). High-quality evidence shows PFMT is >5x more effective in improving UI vs no tx. QOL improves w/ PFMT. PFMT w/ biofeedback using vaginal EMG probe: Low-quality evidence showed increased continence vs no tx; high-quality evidence showed improvement in UI vs no tx.
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⁵ Insufficient evidence for vaginal cones, pessaries, or intravag/intraurethral devices.
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⁶ Exercise/weight loss improved UI in women w/ no evidence of harm; benefits of weight loss extend beyond UI. <br><br>
⁷ Insufficient overall evidence for topical estrogen tx; increased continence/improved UI w/ vaginal estrogen tabs/ovules, but transdermal patches associated w/ worsened UI. Estradiol implant did not improve UI. Low-quality evidence (1 study) showed intravag estriol + PFMT more effectively achieved continence vs intravag estriol alone. Duloxetine improved continence less than placebo and did not statistically significantly improve UI vs placebo; QOL improved w/ duloxetine, but not in women w/ severe stress UI or OAB.