Behavioral vs Drug Treatment for Urge Urinary Incontinence in Older Women: A Randomized Controlled Trial

• Published in: JAMA : the journal of the American Medical Association 1998-12, Vol.280 (23), p.1995-2000
• Main Authors: Burgio, Kathryn L, Locher, Julie L, Goode, Patricia S, Hardin, J. Michael, McDowell, B. Joan, Dombrowski, Marianne, Candib, Dorothy
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Behavior Therapy; Biofeedback, Psychology; Biological and medical sciences; Female; Humans; Mandelic Acids - therapeutic use; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Parasympatholytics - therapeutic use; Patient Satisfaction; Treatment Outcome; Urinary Incontinence - classification; Urinary Incontinence - drug therapy; Urinary Incontinence - therapy; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.280.23.1995

CONTEXT.— Urinary incontinence is a common condition caused by many factors with several treatment options. OBJECTIVE.— To compare the effectiveness of biofeedback-assisted behavioral treatment with drug treatment and a placebo control condition for the treatment of urge and mixed urinary incontinence in older community-dwelling women. DESIGN.— Randomized placebo-controlled trial conducted from 1989 to 1995. SETTING.— University-based outpatient geriatric medicine clinic. PATIENTS.— A volunteer sample of 197 women aged 55 to 92 years with urge urinary incontinence or mixed incontinence with urge as the predominant pattern. Subjects had to have urodynamic evidence of bladder dysfunction, be ambulatory, and not have dementia. INTERVENTION.— Subjects were randomized to 4 sessions (8 weeks) of biofeedback-assisted behavioral treatment, drug treatment (with oxybutynin chloride, possible range of doses, 2.5 mg daily to 5.0 mg 3 times daily), or a placebo control condition. MAIN OUTCOME MEASURES.— Reduction in the frequency of incontinent episodes as determined by bladder diaries, and patients' perceptions of improvement and their comfort and satisfaction with treatment. RESULTS.— For all 3 treatment groups, reduction of incontinence was most pronounced early in treatment and progressed more gradually thereafter. Behavioral treatment, which yielded a mean 80.7% reduction of incontinence episodes, was significantly more effective than drug treatment (mean 68.5% reduction; P=.04) and both were more effective than the placebo control condition (mean 39.4% reduction; P