BEHAVIORAL INTERVENTION FOR COMMUNITY-DWELLING INDIVIDUALS WITH URINARY-INCONTINENCE

Objectives. To review the use of behavioral modification as a treatmen t for urinary incontinence (UI) among individuals in the community. Me thods. The implementation of pelvic floor rehabilitation and bladder t raining is discussed. ''Cure rates'' reported in studies of community- dwelling women with UI are presented, and possible mechanisms of the t reatment effect are described. Results. Clinical trials of behavioral modification for UI have incorporated different therapeutic regimens a nd outcome measurements. On average, however, pelvic muscle rehabilita tion has produced complete resolution in approximately 20% of patients and a 50% to 75% reduction in most individuals. Bladder training has produced complete resolution in fewer than 15% of patients and a 50% t o 75% reduction in more than 50% of subjects. Although the mechanism o f the treatment effect remains undetermined, it may involve modificati on of voluntary striated muscle contractility, reflex striated muscle contractility, cortical inhibition, and cortical facilitation. The str ucture and implementation of the technique, rather than the specific t echnique itself, may be responsible for the treatment, effect. Conclus ions. Behavioral interventions have a definite place in the management of UI. Most such therapies will reduce, rather than abolish, UI. Howe ver, the reduction in symptoms may improve the quality of life. (C) 19 98, Elsevier Science Inc. All rights reserved.