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Am Fam Physician. 2002;66(7):1304-1305

Up to one half of older women have some urinary incontinence, and 15 percent report daily episodes. Of the many treatments available, behavior therapies have been reported to reduce the number of stress- and urge-incontinence episodes by 50 to 80 percent in randomized controlled trials. Many of these modalities, however, are aggressive or time-intensive regimens that require special equipment or staff training and are not suitable for primary care practice. Subak and colleagues evaluated a program of bladder training that could be used in primary care to treat urinary incontinence in older women.

They recruited women who were at least 55 years of age and who reported at least one episode of urinary incontinence per week during the six months before the study. All participants lived independently in the community, and those with uncontrolled diabetes mellitus, urinary tract infection, or significant histories of urinary infection or obstruction were excluded from the study. All participants completed a symptom diary for one week before the study to establish urinary patterns.

The women were randomly assigned to behavior therapy or control status. The 77 women in the intervention group attended six weekly sessions for bladder training given by nurse educators. Sessions included education about urinary tract structure and function, development of individualized voiding schedules, and instruction on Kegel exercises. At each visit, voiding intervals were increased by 30 minutes as tolerated until a target interval of two and one half to three hours was achieved. Urinary diaries were maintained during the six-week therapy period, and a one-week diary was repeated six months after completion of the study. The 75 women in the control group kept urinary diaries for six weeks and were offered behavior training after the study.

After six weeks of therapy, the mean number of incontinent episodes was reduced by one half in the treatment group but by only 15 percent in the control group. Thirty (31 percent) of the 97 women who completed the six-month follow-up achieved complete bladder control, and 40 (41 percent) reported improvement of at least 75 percent. The improvements were not related to the type of incontinence. Improvements began immediately, continued during the study, and were sustained for at least six months. At the six-month follow-up, only 12 percent of participants reported that the program had not been helpful.

The authors conclude that a low-intensity behavior program of bladder training resulted in significant improvements in urinary incontinence that were apparent after four weeks.

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