Behavioral and drug therapy for urinary incontinence☆
Section snippets
Behavioral versus drug therapy
In 1989, recruitment began on the first randomized study of biofeedback-assisted behavioral therapy for urge urinary incontinence. This study was also the first randomized, double-blind, placebo-controlled trial to compare biofeedback-assisted behavioral treatment with drug therapy.2 Behavioral therapy was recommended as first-line treatment for urinary incontinence in the 1996 update of the clinical guidelines published by the Agency for Health Care Policy and Research (now the Agency for
Relation between therapeutic and urodynamic effects
The clinical effects of therapy in patients with urinary incontinence have often been attributed to posttreatment changes in bladder function, but these presumed mechanisms have either not been confirmed or have not been analyzed in studies.10, 11, 12, 13, 14, 15 For example, oxybutynin has been found to increase bladder capacity,16 and this increase has been assumed to be responsible for its therapeutic effect.17 No clinical data supporting this assumption, however, are available.15 Similarly,
Combination therapy
Because behavioral and drug therapies may exert their effects by different mechanisms, combining these therapies could result in additive efficacy for patients with urinary incontinence. Although both behavioral therapy and pharmacotherapy significantly reduced incontinence episodes in the aforementioned randomized, controlled study, the “cure” rate (ie, complete absence of accidents in 2-week bladder diaries, was relatively low (Figure 5). 2 In addition, patients with severe incontinence may
Conclusion
Urinary incontinence is highly prevalent, especially among older women, and can have a major adverse impact on their general health status and quality of life. The need for highly effective and tolerable therapies is clear. In the first randomized clinical trial comparing biofeedback-assisted behavioral therapy with both a standard drug treatment and a control condition in patients with urinary incontinence, it was shown that both treatments significantly improved incontinence compared with
Acknowledgements
The author wishes to acknowledge the Veterans Affairs Rehabilitation Research and Development Service for its valuable assistance in investigating the potential value of combination therapy for urge urinary incontinence in the above-mentioned, ongoing study.
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Cited by (26)
Urinary Incontinence in the Elderly
2009, Clinics in Geriatric MedicineCitation Excerpt :Pelvic floor relaxation techniques are also an important component of PFMT, particularly in patients with urgency and urge UI. Some studies support the combined use of PFMT and medications in this patient population.29,30 Research on the feasibility and use of PFMT in elderly patients with cognitive impairment has been limited.
Mixed urinary incontinence
2008, Female Urology: Text with DVDMixed Urinary Incontinence
2008, Female UrologyChronic Disease and Geriatrics
2007, Palliative CareUrinary Incontinence: Selected Current Concepts
2006, Medical Clinics of North AmericaCitation Excerpt :Nonpharmacologic management should be the first line of therapy in all cases. In the subset of patients who fail to respond, the addition of pharmacologic agents is a viable option [49,50]. The increased risk for adverse drug effects and interactions in older adults, however, mandates due caution with drug selection and dosing.
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This work was supported by the National Institutes of Health Grant Nos. R01DK49472, and R01AG08010.
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Patricia S. Goode has been a paid consultant to Alza, Eli Lilly, Pharmacia, and Yamanouchi