Efficacy of bladder training in older women with urinary incontinence

Article Abstract:

Almost two out of five women over the age of 60 suffer from urinary incontinence (UI), and many of these women also have the need to urinate frequently at night. The medical, social, and psychological consequences of bladder incontinence are difficult to cope with, and the economic consequences have been estimated to reach seven billion dollars a year. A ''bladder discipline'' or ''bladder drill'' program was developed twenty-five years ago, and has been used primarily for women with uninhibited bladder contractions (detrusor instability, or DI), which affects 10 to 20 percent of women who are incontinent. Cure rates for women with DI range from 44 percent to 100 percent, but controlled trials are few. This study of 123 women over 55 included those with urethral sphincter incompetence (SI) as well. Women with SI were generally excluded from other studies because this was considered an anatomical condition. Bladder training reduced the number of UI episodes, the amount of fluid lost, and frequency of urination both during the day and at night. For 12 percent of the women there were no UI episodes, and there was a 50 percent improvement in 75 percent of the women. Other studies report a cure rate of 44 percent to 78 percent, but their methods of patient selection are not known. Other therapies report significant cure rates as well. Bladder training significantly reduced all the adverse outcomes, and was dependent on the severity of the symptoms at the beginning of the study. Surprisingly, outcomes were the same for women with SI and with DI, indicating that these conditions may not be independent. Bladder training has no adverse consequences, and should be considered before surgery and drug therapy, both of which have significant risks and side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Women, Prevention, Causes of, Women's health, Aged women, Elderly women

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Bladder training in older women with urinary incontinence: relationship between outcome and changes in urodynamic observations

Article Abstract:

Bladder training is a behavioral approach for correcting urinary incontinence in women with functional but not anatomic bladder problems. To evaluate its effectiveness, a controlled, randomized study was carried out in community-dwelling (noninstitutionalized) incontinent women. The first step in the study was to evaluate the effect of the program in women with sphincteric incompetence (the urinary sphincter tightens to retain urine) or detrusor instability (abnormality of the part of the bladder's muscular wall) with or without sphincteric incompetence. The 108 participants in the study experienced half the number of incontinent episodes after training, regardless of the bladder problem they had. The second phase of the study, reported here, examined whether the improved function was maintained during a six-month follow-up period. In general, bladder training had little effect on objective measures of patients' abilities to store or hold urine in the bladder, or in patients' ability to void effectively (urodynamic variables). Women who had no urodynamic abnormalities at follow-up had the same number of episodes of incontinence as those with abnormalities. The results indicate that bladder training is effective by means of changes unrelated to urodynamic parameters. These changes may consist mainly of behavioral and functional adaptations. Whether physiological changes underlie improved bladder function after bladder training is a subject for future research. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Bowel and bladder training, Bladder training, Bowel training

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Comparative efficacy of behavioral interventions in the management of female urinary incontinence

Article Abstract:

Combination therapy was found most effective immediately after treatment for urinary incontinence in women in a study comparing bladder training, pelvic muscle exercise with biofeedback, and therapy involving a combination of both methods. Three months after treatment, however, similar results were obtained from the three treatment conditions. A randomized clinical trial was conducted with 204 women.

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