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ORIGINAL RESEARCH |
From the Department of Obstetrics, Gynecology, and Reproductive Sciences, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; Kaiser Foundation Research Institute, Division of Research, Oakland, California; and Kaiser Permanente Medical Center, Department of Urology, Oakland, California.
Address reprint requests to: Leslee L. Subak, MD, University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, 1635 Divisadero Street, Suite 600, San Francisco, CA 94115; E-mail: subakl{at}obgyn.ucsf.edu.
OBJECTIVE: To evaluate the effect of a low-intensity behavioral therapy program on urinary incontinence in older women.
METHODS: A randomized clinical trial for community-dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted. Women were randomly assigned to a behavioral therapy group (n = 77) or a control group (n = 75). The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules. The control group received no instruction but kept urinary diaries for 6 weeks. After this period, the control group underwent the behavioral therapy protocol. Using per-protocol analyses, t and 
2 tests were used to compare the treatment and control groups, and paired t tests were used to evaluate the efficacy of behavioral therapy for all women (treatment and control groups before and after behavioral therapy).
RESULTS: Women in the treatment group experienced a 50% reduction in mean number of incontinent episodes recorded on a 7-day urinary diary compared with a 15% reduction for controls (P = .001). After behavioral therapy, all women had a 40% decrease in mean weekly incontinent episodes (P = .001), which was maintained over 6 months (P < .004). Thirty (31%) women were 100% improved (dry), 40 (41%) were at least 75% improved, and 50 (52%) at least 50% improved. There were no differences in treatment efficacy by type of incontinence (stress, urge, mixed) or group assignment (treatment, control).
CONCLUSION: A low-intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first-line treatment for urinary incontinence in older women.
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