Behavioral vs drug treatment for urge urinary incontinence in older women - A randomized controlled trial

Context.-Urinary incontinence is a common condition caused by many factors with several treatment options. Objective.-To compare the effectiveness of biofeedback-assisted behavioral treatment with drug treatment and a placebo control condition for the treat ment of urge and mixed urinary incontinence in older community-dwelling wom en. Design.-Randomized placebo-controlled trial conducted from 1989 to 1995. Setting.-University-based outpatient geriatric medicine clinic. Patients.-A volunteer sample of 197 women aged 55 to 92 years with urge uri nary incontinence or mixed incontinence with urge as the predominant patter n. Subjects had to have urodynamic evidence of bladder dysfunction, be ambu latory, and not have dementia, Intervention.-Subjects were randomized to 4 sessions (8 weeks) of biofeedba ck-assisted behavioral treatment, drug treatment (with oxybutynin chloride, possible range of doses, 2.5 mg daily to 5.0 mg 3 times daily), or a place bo control condition. Main Outcome Measures.-Reduction in the frequency of incontinent episodes a s determined by bladder diaries, and patients' perceptions of improvement a nd their comfort and satisfaction with treatment. Results.-For all 3 treatment groups, reduction of incontinence was most pro nounced early in treatment and progressed more gradually thereafter. Behavi oral treatment, which yielded a mean 80.7% reduction of incontinence episod es, was significantly more effective than drug treatment (mean 68.5% reduct ion; P=.04) and both were more effective than the placebo control condition (mean 39.4% reduction; P<.001 and P=.009, respectively). Patient-perceived improvement was greatest for behavioral treatment (74.1% "much better" vs 50.9% and 26.9% for drug treatment and placebo, respectively). Only 14.0% o f patients receiving behavioral treatment wanted to change to another treat ment vs 75.5% in each of the other groups. Conclusion.-Behavioral treatment is a safe and effective conservative inter vention that should be made more readily available to patients as a first-l ine treatment for urge and mixed incontinence.