COMPARATIVE EFFICACY OF BEHAVIORAL INTERVENTIONS IN THE MANAGEMENT OFFEMALE URINARY-INCONTINENCE

OBJECTIVE: We compared the efficacy of bladder training, pelvic muscle exercise with biofeedback-assisted instruction, and combination thera py, on urinary incontinence in women. The primary hypothesis was that combination therapy would be the most effective in reducing incontinen t episodes. STUDY DESIGN: A randomized clinical trial with three treat ment groups was conducted in gynecologic practices at two university m edical centers. Two hundred and four women diagnosed with genuine stre ss incontinence (n = 145) and/or detrusor instability (n = 59) receive d a 12-week intervention program (6 weekly office visits and 6 weeks o f mail/telephone contact) with immediate and 3-month follow-up. Outcom e variables included number of incontinent episodes, quality of life, perceived improvement, and satisfaction. Data analyses consisted of an alysis of covariance using baseline values as covariates and chi(2) te sts. RESULTS: The combination therapy group had significantly fewer in continent episodes, better quality of life, and greater treatment sati sfaction immediately after treatment. No differences among groups were observed 3 months later. Women with genuine stress incontinence had g reater improvement in life impact, and those with detrusor instability had less symptom distress at the immediate follow-up; otherwise, no d ifferences were noted by diagnosis, incontinence severity, or treatmen t site. CONCLUSIONS: Combination therapy had the greatest immediate ef ficacy in the management of female urinary incontinence regardless of urodynamic diagnosis. However, each of the 3 interventions had similar effects 3 months after treatment. Results suggest that the specific t reatment may not be as important as having a structured intervention p rogram with education, counseling, and frequent patient contact.