BERKELEY, CA (UroToday Inc.) - Behavioral techniques, including pelvic floor muscle training and bladder training, have been found to be safe and effective for stress, urge and mixed urinary incontinence. No randomized controlled trials of a behavioral modification program for the prevention of urinary incontinence in older women have been previously published.

A study was initiated to determine whether a behavioral modification program provided for groups of ambulatory, postmenopausal, continent women 55 to 80 years old would decrease the incidence of urinary incontinence, increase pelvic floor muscle strength and improve voiding control. A.C. Diokno et al., reported their study from William Beaumont Hospital in Ann Arbor, Michigan, and published it in the March, 2004 issue of the Journal of Urology.

A total of 195 control and 164 treated participants were prospectively entered into the study. The treatment group attended a two-hour classroom presentation on bladder and pelvic floor muscle training followed by a visit 2 to 4 weeks later to test skills and reinforce techniques. Follow-up was performed by mail or telephone every three months and completed with a final clinical evaluation at 12 months. Outcome measures were continence status, pelvic floor muscle strength and voiding frequency/intervoid interval.

Results showed that at baseline, both the control and treatment groups reported a 39% absolute continence rate and 61% reported 1 to 5 days of incontinence episodes in the past one-year. After 12 months, 56% of the treatment group reported the same or better results versus 41% for the control group (p=0.01). In addition, at the 12-month exit physical exam, the treatment group had significantly higher pelvic floor muscle pressure scores than the control group (p=0.0003).

Three-day voiding diaries were used to assess intervoid interval and mean voiding frequencies during a 24-hour period. In both indices, the treatment group showed significant improvement over the control group. The intervoid interval increased by 33 minutes in the treatment group versus an increase of only 2 minutes in the control group. There was no statistically significant correlation between continence status with improved pelvic floor muscle strength or improved voiding frequency/intervoid interval at 12 months.

This behavioral modification program of combined bladder and pelvic floor muscle training demonstrates feasibility and efficacy in improving continence status, pelvic muscle strength and voiding control as long as one year after treatment in older women.

J Urol. 2004;171:1165-71