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J Am Geriatr Soc. 2000 Apr;48(4):370-4.

Combined behavioral and drug therapy for urge incontinence in older women.

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  • 1University of Alabama at Birmingham School of Medicine and Center for Aging, USA.

Abstract

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.

PMID:
10798461
[PubMed - indexed for MEDLINE]
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