title: Prevention of urinary incontinence by behavioral modification program: a randomized, controlled trial among older women in the community.
abstract: OBJECTIVE
  We determined whether a behavioral modification program (BMP) taught to groups of continent older women would decrease the incidence of urinary incontinence, increase pelvic muscle strength and improve voiding control.
  
  
  METHODS
  We performed a randomized, controlled trial comparing a BMP treatment group to a control, no treatment group in ambulatory, postmenopausal, continent women (0 to 5 days of incontinent episodes in the previous year) 55 years and older who were followed for 12 months. Qualified volunteers from 4 Michigan counties were randomly assigned to a control or a treatment group, consisting of a 2-hour classroom presentation on BMP followed 2 to 4 weeks later with individualized evaluation to test knowledge, adherence and skills in behavioral techniques, and brief reinforcement of the technique as needed. Followup was done by telephone and mail every 3 months except month 12, when all participants underwent final clinical evaluation. Outcome measures were continence status, pelvic floor muscle strength and voiding frequency/intervoid interval.
  
  
  RESULTS
  A total of 195 control and 164 treated participants completed the study. Baseline data on the 2 groups were not statistically different. At 12 months the treatment group was statistically significantly better than the control group in continence status (p = 0.01), pelvic muscle strength (pressure score p = 0.0003 and displacement score p <0.0001), improved voiding frequency (p <0.0001) and intervoid interval (p <0.0001).
  
  
  CONCLUSIONS
  To our knowledge we report the first randomized, controlled trial of BMP for preventing urinary incontinence in older women. It demonstrated feasibility and efficacy in improving continence status, pelvic muscle strength and voiding control as long as a year after treatment.
authors.affiliation: Department of Urology, William Beaumont Hospital, University of Michigan, Ann Arbor, Michigan 48073, USA. adiokno@beaumont.edu
authors.forename: Ananias C
authors.initials: AC
authors.lastname: Diokno
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Sampselle
authors.forename: A Regula
authors.initials: AR
authors.lastname: Herzog
authors.forename: T E
authors.initials: TE
authors.lastname: Raghunathan
authors.forename: Sandra
authors.initials: S
authors.lastname: Hines
authors.forename: Kassandra  L
authors.initials: K
authors.lastname: Messer
authors.forename: Cindy
authors.initials: C
authors.lastname: Karl
authors.forename: Maria Claudia A
authors.initials: MC
authors.lastname: Leite
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D014549:Urinary Incontinence / Q000503:physiopathology / Q000517:prevention & control*; D014554:Urination