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 treatment of urge and mixed urinary
incontinence in older community-dwelling women.
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 urinary incontinence or mixed incontinence with urge as
the predominant pattern. Subjects had to have urodynamic evidence of
bladder dysfunction, be ambulatory, and not have dementia.
Intervention.— Subjects were randomized to 4 sessions (8
weeks) of biofeedback-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 placebo control condition.
Main Outcome Measures.— Reduction in the frequency of
incontinent episodes as determined by bladder diaries, and patients'
perceptions of improvement and their comfort and satisfaction with
treatment.
Results.— For all 3 treatment groups, reduction of
incontinence was most pronounced early in treatment and progressed more
gradually thereafter. Behavioral treatment, which yielded a mean 80.7%
reduction of incontinence episodes, was significantly more effective
than drug treatment (mean 68.5% reduction;
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% of patients receiving behavioral treatment
wanted to change to another treatment vs 75.5% in each of the other
groups.
Conclusion.— Behavioral treatment is a safe and effective
conservative intervention that should be made more readily available to
patients as a first-line treatment for urge and mixed
incontinence.