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Combined Behavioral and Drug Therapy for Urge Incontinence in Older Women
Author(s) -
Burgio Kathryn L.,
Locher Julie L.,
Goode Patricia S.
Publication year - 2000
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2000.tb04692.x
Subject(s) - medicine , urinary incontinence , physical therapy , pharmacotherapy , ambulatory , placebo , randomized controlled trial , oxybutynin , biofeedback , clinical trial , overactive bladder , surgery , alternative medicine , pathology
OBJECTIVE : The purpose of this study was to examine the effects of combining behavioral treatment and drug treatment for urge incontinence in community‐dwelling older women. DESIGN : Modified crossover design (extension of a randomized clinical trial). Eligible subjects were stratified according to type and severity of incontinence and randomized to behavioral treatment, drug treatment, or a control condition (placebo). Subjects not totally continent or not satisfied after 8 weeks of a single treatment were offered the opportunity to cross over into combined therapy. SETTING : A university‐based outpatient geriatric medicine clinic. PARTICIPANTS : Subjects in the clinical trial were 197 ambulatory, nondemented, community‐dwelling women (age 55 years or older) with persistent urge urinary incontinence. Thirty‐five subjects participated in combined treatment. INTERVENTION : One group of subjects received four sessions (over 8 weeks) of biofeedback‐assisted behavioral training followed by 8 weeks of behavioral training combined with drug therapy (oxybutynin chloride individually titrated from 2.5 mg to 15 mg daily). The second group received drug therapy first, followed by 8 weeks of drug therapy combined with behavioral training. MEASUREMENTS : Bladder diaries completed by subjects before and after each treatment phase were used to calculate change in the frequency of incontinent episodes. RESULTS : Eight subjects (12.7%) crossed from behavioral treatment alone to combined behavioral and drug therapy. Additional benefit was seen in improvement from a mean 57.5% reduction of incontinence with single therapy to a mean 88.5% reduction of incontinence with combined therapy ( P = .034). Twenty‐seven subjects (41.5%) crossed from drug therapy alone to combined drug and behavioral treatment. They also showed additional improvement, from a mean 72.7% reduction of incontinence with single therapy to a mean 84.3% reduction of incontinence with combined therapy (P = .001). CONCLUSIONS : This study shows that combining drug and behavioral therapy in a stepped program can produce added benefit for patients with urge incontinence. J Am Geriatr Soc 48: 370–374, 2000 .