Combined behavioral and drug therapy for urge incontinence in older women

OBJECTIVE: The purpose of this study was to examine the effects of combinin g behavioral treatment and drug treatment for urge incontinence in communit y-dwelling older women. DESIGN: Modified crossover design (extension of a randomized clinical trial ). Eligible subjects were stratified according to type and severity of inco ntinence and randomized to behavioral treatment, drug treatment, or a contr ol condition (placebo). Subjects not totally continent or not satisfied aft er 8 weeks of a single treatment were offered the opportunity to cross over into combined therapy. SETTING: A university-based outpatient geriatric medicine clinic. PARTICIPANTS: Subjects in the clinical trial were 197 ambulatory, nondement ed, community-dwelling women (age 55 years or older) with persistent urge u rinary incontinence. Thirty-five subjects participated in combined treatmen t. INTERVENTION: One group of subjects received four sessions (over 8 weeks) o f biofeedback-assisted behavioral training followed by 8 weeks of behaviora l training combined with drug therapy (oxpbutynin chloride individually tit rated from 2.5 mg to 15 mg daily). The second group received drug therapy f irst, followed by 8 weeks of drug therapy combined with behavioral training . MEASUREMENTS: Bladder diaries completed by subjects before and after each t reatment phase were used to calculate change in the frequency of incontinen t episodes. RESULTS: Eight subjects (12.7%) crossed from behavioral treatment alone to combined behavioral and drug therapy. Additional benefit was seen in improv ement from a mean 57.5% reduction of incontinence with single therapy to a mean 88.5% reduction of incontinence with combined therapy (P = .034). Twen ty-seven subjects (41.5%) crossed from drug therapy alone to combined drug and behavioral treatment. They also showed additional improvement, from a m ean 72.7% reduction of incontinence with single therapy to a mean 84.3% red uction of incontinence with combined therapy (P = .001). CONCLUSIONS: This study shows that combining drug and behavioral therapy in a stepped program can produce added benefit for patients with urge inconti nence.