Comparative efficacy of behavioral interventions in the management of female urinary incontinence

• Published in: American journal of obstetrics and gynecology Vol. 179; no. 4; pp. 999 - 1007
• Main Authors: Wyman, Jean F., Fantl, J.Andrew, McClish, Donna K., Bump, Richard C.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.10.1998; Elsevier
• Subjects: Behavioral therapy; biofeedback; Biological and medical sciences; female; Medical sciences; Nephrology. Urinary tract diseases; urinary incontinence; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; biofeedback; Behavioral therapy; female; urinary incontinence; Physical exercise; Human; Urinary system disease; Treatment efficiency; Urinary tract disease; Method; Perineum; Voiding dysfunction; Reeducation; Follow up study; Detrusor muscle; Female; Instability; Bladder disease; Behavior therapy; Comparative study; Urinary stress incontinence
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(98)70206-6

Objective: We compared the efficacy of bladder training, pelvic muscle exercise with biofeedback-assisted instruction, and combination therapy, on urinary incontinence in women. The primary hypothesis was that combination therapy would be the most effective in reducing incontinent episodes. Study Design: A randomized clinical trial with three treatment groups was conducted in gynecologic practices at two university medical centers. Two hundred and four women diagnosed with genuine stress incontinence (n = 145) and/or detrusor instability (n = 59) received a 12-week intervention program (6 weekly office visits and 6 weeks of mail/telephone contact) with immediate and 3-month follow-up. Outcome variables included number of incontinent episodes, quality of life, perceived improvement, and satisfaction. Data analyses consisted of analysis of covariance using baseline values as covariates and χ2 tests. Results: The combination therapy group had significantly fewer incontinent episodes, better quality of life, and greater treatment satisfaction immediately after treatment. No differences among groups were observed 3 months later. Women with genuine stress incontinence had greater improvement in life impact, and those with detrusor instability had less symptom distress at the immediate follow-up; otherwise, no differences were noted by diagnosis, incontinence severity, or treatment site. Conclusions: Combination therapy had the greatest immediate efficacy in the management of female urinary incontinence regardless of urodynamic diagnosis. However, each of the 3 interventions had similar effects 3 months after treatment. Results suggest that the specific treatment may not be as important as having a structured intervention program with education, counseling, and frequent patient contact. (Am J Obstet Gynecol 1998;179:999-1007.)