Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group.
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.


METHODS
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 chi2 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.
Wyman
J F
JF
Department of Adult Health Nursing, Virginia Commonwealth University/Medical College of Virginia, Richmond, USA.
Fantl
J A
JA
McClish
D K
DK
Bump
R C
RC
D000368:Aged; D001521:Behavior Therapy; D001676:Biofeedback, Psychology; D003131:Combined Modality Therapy; D004522:Educational Status; D015914:Estrogen Replacement Therapy; D015444:Exercise; D005260:Female; D006801:Humans; D008875:Middle Aged; D009132:Muscles / Q000503:physiopathology; D011788:Quality of Life; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D014549:Urinary Incontinence / Q000503:physiopathology / Q000628:therapy*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000628:therapy