The effect of behavioral therapy on urinary incontinence: a randomized controlled trial

doi:10.1016/S0029-7844(02)01993-2

Obstetrics & Gynecology

Volume 100, Issue 1, July 2002, Pages 72-78

https://doi.org/10.1016/S0029-7844(02)01993-2 Get rights and content

Abstract

OBJECTIVE:

To evaluate the effect of a low-intensity behavioral therapy program on urinary incontinence in older women.

METHODS:

A randomized clinical trial for community-dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted. Women were randomly assigned to a behavioral therapy group (n = 77) or a control group (n = 75). The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules. The control group received no instruction but kept urinary diaries for 6 weeks. After this period, the control group underwent the behavioral therapy protocol. Using per-protocol analyses, t and χ² tests were used to compare the treatment and control groups, and paired t tests were used to evaluate the efficacy of behavioral therapy for all women (treatment and control groups before and after behavioral therapy).

RESULTS:

Women in the treatment group experienced a 50% reduction in mean number of incontinent episodes recorded on a 7-day urinary diary compared with a 15% reduction for controls (P = .001). After behavioral therapy, all women had a 40% decrease in mean weekly incontinent episodes (P = .001), which was maintained over 6 months (P < .004). Thirty (31%) women were 100% improved (dry), 40 (41%) were at least 75% improved, and 50 (52%) at least 50% improved. There were no differences in treatment efficacy by type of incontinence (stress, urge, mixed) or group assignment (treatment, control).

CONCLUSION:

A low-intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first-line treatment for urinary incontinence in older women.

Section snippets

Materials and methods

Women 55 years and older reporting urinary incontinence were recruited at a northern California health maintenance organization. This study protocol was approved by the institutional review board. Physicians and nurse practitioners were asked to refer ambulatory female patients who reported at least one urinary incontinent episode per week over the past 6 months. A consecutive cohort of participants were recruited in 1995 until enrollment of the estimated sample size and 25% for dropout was

Results

We enrolled 152 women in the study, with 77 randomized to the treatment group and 75 to the control group. Eleven women in the treatment group and 18 in the control group were lost to follow-up or dropped out of the study before completing 6 weeks of data collection and were not included in the final analyses. There were no differences in demographic characteristics, medical, gynecologic, or urologic history, current urologic symptoms, or incontinence severity at baseline between women

Discussion

Women experienced a significant improvement in incontinence frequency after a low-intensity behavioral therapy program using bladder training. This effect was observed in the therapy group (treatment) in the randomized controlled trial (P = .001) and in all women after therapy (combined treatment and control groups for pre- and post-therapy results, P = .001). Improvement was maintained over 6 months (P = .004). This low-intensity behavioral therapy program resulted in statistically significant

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^☆: This work was supported by Direct Community Benefit Investment, Kaiser Foundation Research Institute.

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Original researchThe effect of behavioral therapy on urinary incontinence: a randomized controlled trial☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Obstet Gynecol

Urology

Obstet Gynecol

Urology

Urology

J Urol

Am J Obstet Gynecol

Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly

J Urol

The quality of life in women with urinary incontinence as measured by the sickness impact profile

J Am Geriatr Soc

Original research
The effect of behavioral therapy on urinary incontinence: a randomized controlled trial☆