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Using Nonpharmacologic Interventions for Incontinence



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Am Fam Physician. 2003 Feb 15;67(4):856-859.

Urge urinary incontinence is commonly treated with medications, but behavior techniques are also effective. Biofeedback-assisted behavior training has been shown to produce 76 to 86 percent improvement in urge incontinence, making this technique at least as effective as or even more effective than drug therapy. Compared with other training measures, biofeedback-assisted behavior training, which involves electrode placement, is more expensive. Burgio and colleagues compared the effectiveness of behavior training with and without biofeedback in the treatment of urge urinary incontinence in older women.

Study participants included 222 nondemented, community-dwelling women between 55 and 92 years of age who had urodynamic confirmation of urge incontinence. Bladder diaries kept for two weeks were used to stratify the incontinence as mild (fewer than five episodes per week), moderate (five to 10 episodes per week), and severe (more than 10 episodes per week).

The women were randomized to receive behavior treatment with biofeedback, behavior training without biofeedback (use of verbal feedback based on vaginal palpation), or a self-help booklet that taught behavior techniques (control group). Over the eight-week treatment period, each woman kept a bladder diary. The biofeedback and verbal feedback groups had clinic visits at two-week intervals for further teaching and reinforcement. Satisfaction and quality-of-life measures were assessed before and after treatment.

Behavior treatment with biofeedback produced a mean 63.1 percent reduction in accident frequency, and behavior treatment with verbal feedback reduced accidents by 69.4 percent. The group that used the self-help booklet had a mean 58.6 percent reduction in accident frequency. The differences in the three groups were not statistically significant.

Post-treatment cystometrograms were obtained in a subgroup of patients drawn from the three groups. The findings showed statistically significant improvement in bladder capacity across all three groups but no differences between groups. Patient satisfaction with the progress made in controlling episodes of urge urinary incontinence was significant in the biofeedback and verbal feedback groups compared with the control group. Quality-of-life measures improved significantly in all three groups.

The three behavior measures were equally effective in reducing urge urinary incontinence. Increased satisfaction with the biofeedback and verbal feedback interventions may have been due to the support and encouragement the women in these groups received from clinic staff. The authors recommended use of a self-help booklet or verbal feedback as initial treatment, with biofeedback-assisted behavior training reserved for use in refractory cases. This strategy is consistent with present reimbursement policies.

Burgio KL, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women. JAMA. November 13, 2002;288:2293–9.


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