The effect of behavioral therapy on urinary incontinence: a randomized controlled trial.
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 chi(2) 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).


CONCLUSIONS
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.
Subak
Leslee L
LL
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 94115, USA. subak@obgyn.ucsf.edu
Quesenberry
Charles P
CP
Posner
Samuel F
SF
Cattolica
Eugene
E
Soghikian
Krikor
K
D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000523:psychology / Q000628:therapy*