- Mean 2·25 incontinence episodes/day in the intervention group (−61%)
- 92% of patients in the intervention group showed improvement
- 23% were completely continent at study end
- Symptom severity (ICIQ-SF): −3·9 points (IG) vs. −0·3 (CG)
- → clinically relevant threshold clearly exceeded
- Quality of life (I-QOL): +17·3 points (IG) vs. +1·2 (CG)
- → all subscales improved (social embarrassment, psychosocial impacts, avoidance & limiting behaviours)
- Patient activation (PAM-13): +5·1 points (IG) vs. −0·2 (CG)
- Pad usage: −27·8% (IG) vs. +2·4% (CG)
Importantly, urinary incontinence is not only a physical condition but is strongly associated with stigma, shame, and social withdrawal. The large improvements observed in all I-QoL subscales—including social embarrassment and avoidance behaviours—indicate that symptom reduction translated into tangible psychosocial benefits. This aligns with population data showing that many women delay or avoid care due to embarrassment, contributing to persistent treatment gaps.
At the same time, conservative management of incontinence typically requires multiple modalities—pelvic floor physiotherapy, bladder training, behavioural therapy, lifestyle counselling, and psychological support. In routine practice, delivering and coordinating these components is often difficult due to organisational complexity and shortages of specialised healthcare personnel, resulting in fragmented or delayed care.
Digital therapeutics offer a scalable way to integrate these modalities into a single structured programme. The DINKS intervention combines pelvic floor training with bladder training, cognitive behavioural strategies, mindfulness exercises, and lifestyle guidance—an approach that would be challenging to provide consistently through traditional care pathways alone.
From the patient perspective, digital therapies support active self-management. The observed increase in patient activation (PAM-13) suggests that patients not only improved clinically, but also gained confidence and skills to manage their condition independently. Patients can also generate therapy reports including PROMs, bladder diary data, symptom trajectories, and adherence metrics, and choose to share these with their physicians, supporting personalised clinical decision-making.
Beyond clinical outcomes, the significant reduction in pad usage has relevant sustainability implications. Incontinence products contribute substantially to healthcare-related waste and carbon emissions, and long-term reductions may meaningfully lower environmental impact.
Finally, it is essential to emphasise that this intervention is a highly regulated digital health product. The app is certified as a Digital Health Application (DiGA) by Germany’s Federal Institute for Drugs and Medical Devices (BfArM), requiring stringent data protection standards and proof of positive healthcare effects in a randomised controlled trial.
Given the substantial global burden of urinary incontinence—including economic costs, environmental consequences, and workforce shortages—scalable digital interventions represent a critical strategy for sustainable healthcare delivery. The improvements observed in DINKS support implementation models in which digital therapeutics serve as effective first-line interventions and may reduce progression to pharmacological or surgical treatments.
Written by: Lisa Frey,1 and Laura Wiemer2
- Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
- Department of Clinical Research, Kranus Health, Munich, Germany; Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.