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AUA 2018

AUA 2018: A Randomized Trial of a Group-Based Therapeutic Yoga Program for Ambulatory Women with Urinary Incontinence

San Francisco, CA USA (UroToday.com) This podium session began with a study that evaluated a new approach to the treatment of urinary incontinence (UI). Alternatives to current treatments for overactive bladder are needed, especially for older patients who are more susceptible to the side effects of anticholinergic medications. The practice of yoga has become very popular in the last decade and is thought to have many benefits including increased strength, balance, and flexibility, as well as to decrease stress. The authors here investigate the feasibility and tolerability, as well as the effects on urinary incontinence, of an organized yoga program in community-dwelling older women.

This was a single center, randomized, parallel group trial of the changes in UI in women participating in an organized yoga program versus controls. The yoga group received instruction during twice-weekly group and once-weekly home yoga practice. The control group had time-equivalent classes in stretching and strengthening that were non-specific. The yoga program was developed by experts in Iyengar yoga with 15 standard poses, and a focus on mindful awareness. Women were eligible for the study if they were greater than 50 years old, able to walk 2 blocks, had at least daily UI, had not participated in yoga for past year, and were willing to forgo other therapies for UI. Outcomes evaluated were the change in UI frequency on voiding diary at baseline and at 3 months.

56 women were randomized in a 1:1 ratio of yoga to control. 1 subject in the yoga group and 5 subjects in the control group discontinued the study early, but all subjects were included in the intent to treat analysis. Adherence to both the yoga and control programs were greater than 85%. The majority of subjects was found to have at least moderate confidence in performing the exercises and was observed to perform the exercises with at least moderate success. There were no serious adverse events. No adverse events were attributed to the yoga except for one woman who tripped over a yoga block at home when not practicing the yoga. Both groups experienced a significant decrease in UI episodes per week, but the between-group difference in change in incontinence was not significant. There was a 76% decrease in incontinence episodes per week in the yoga group and 56% decrease in the control group (p=0.07). The percent decrease in stress UI and daytime UI was significantly better in the yoga group, while there was no significant difference between groups for percent decrease in urgency UI or daytime UI.

Overall this was a study that highlighted a safe, feasible, and well-tolerated treatment for urinary incontinence, which may be enjoyable for many patients. While the evidence for its effectiveness is not strong, there were a small number of patients enrolled, and larger studies may reveal larger differences between groups. It has good potential for a community-based, group approach for both the treatment and prevention of UI.

Presented by: Alison Huang, MD

Written by: Dena Moskowitz, MD, Fellow, Female Pelvic Medicine and Reconstructive Surgery, Virginia Mason Medical Center, Twitter: @demoskowitz at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA