doctor talking to patient

Twenty-five years--that is how long one woman suffered with severe urinary incontinence (UI) before she worked up the courage to discuss her symptoms with her doctor and realized there were treatment options available for her. Two and a half decades characterized by shame and guilt, growing more and more accustomed to allowing her bladder to make life decisions for her. The more her symptoms progressed, the more she began limiting her activities and withdrawing from social interactions. Walking her dog, shopping for groceries, going out to eat with families, participating in religious worship—what should have been basic, day-to-day activities became moments to worry about where the nearest bathroom was located or what she would do if she had an accident.

Many women can relate to this story. According to the Mayo Clinic, 50 percent of adult women are affected by UI, or involuntary bladder leakage. Despite being a common problem, two-thirds of women haven’t spoken to their doctor about their symptoms, largely due to the stigma and embarrassment surrounding this issue, as well as the false assumption that this is a normal side effect of aging.

While UI is not a life-threatening condition, its symptoms undoubtedly impact health and quality of life. Some women experiencing bladder leakage may avoid engaging in physical activities that support wellbeing. Older women experiencing incontinence are at a greater risk for fractures, falls, and nursing home admissions.

The shame and embarrassment of managing UI coupled with the potential for increased social isolation can affect one’s mental health. Studies report that even when accounting for other medical conditions and demographic differences, UI negatively affects quality of life and increases the risk of depressive or psychologically distressing symptoms.

Unfortunately, countless women endure the negative effects of UI despite the availability of safe and effective nonsurgical treatments. A recent Agency for Healthcare Quality and Research (AHRQ) systematic review found that less than 30 percent of women over 40 with UI report receiving care for symptoms.

Primary care is in a unique position to address the silent suffering of many women with UI. As primary care aims to provide whole-person care throughout the life span, it is well-suited to identify and manage day-to-day health and quality of life needs. However, addressing UI can seem daunting for primary care providers who are navigating 15-minute appointment intervals and a long list of competing health priorities that must be addressed during their time with the patient.

Recognizing the need to close the evidence-to-practice gap, AHRQ launched their Managing Urinary Incontinence (MUI) initiative in February  2022 to help primary care practices offer effective nonsurgical UI interventions to women. The MUI initiative is the latest iteration of AHRQ’s EvidenceNOW Model, a blueprint for providing external support to primary care practices to improve health care quality and implement new evidence into care delivery. The five AHRQ grantees in the MUI initiative are testing novel ways to disseminate and implement evidence-based UI care for women with sets of primary care practice in different regions in the U.S. Grantee projects designed their unique interventions with special consideration to avoid placing additional burden on primary care clinicians. As such, the projects  feature streamlined practice facilitation methods, mobile health programs for pre-appointment screening and patient education, and delegating care using advanced practice providers (such as nurse practitioners and/or physician assistants) and e-consults with UI specialists.

Now a year and a half into their projects, grantee teams have gained valuable insights regarding best practices for UI screening, treatment, and referral in primary care. As part of these efforts, the projects have also developed a variety of tools and resources to help primary care practices implement evidence-based care and improve the quality UI treatment. Resources include recruitment materials, patient and provider educational materials, EHR clinical decision support tools, and best practices for sustainability, among others.

Join AHRQ and the grantees on November 6, 2023, from 2:00-3:30pm ET to learn more about the progress of the MUI initiative. The MUI grantees will highlight the resources, tools, and methods they have created and discuss how these resources can be adopted in primary care settings to improve UI treatment for women. Register here:


Brianna Bragg

Research Associate - AcademyHealth

Brianna Bragg is a Research Associate at AcademyHealth, where she supports the AHRQ-funded EvidenceNOW: Managi... Read Bio


Gena Dunivan, M.D.

Division Chief of Urogynecology and Reconstructive Pelvic Surgery - University of Alabama at Birmingham

Gena Dunivan, M.D., is the Division Chief of Urogynecology and Reconstructive Pelvic Surgery at the University... Read Bio

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