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Behavioral treatment reduces urinary incontinence

A new group-administered behavioral treatment program was safe, cost-effective, reduced urinary incontinence frequency and severity, and improved quality of life among older women, according to a study published in JAMA Internal Medicine.

“Urinary incontinence guidelines recommend behavioral interventions as first-line treatment using individualized approaches,” Ananias C. Diokno, MD, from the department of urology at Beaumont Hospital, Michigan, and colleagues wrote. “A one-time, group-administered behavioral treatment could enhance access to behavioral treatment.”

Diokno and colleagues conducted a multisite clinical trial to examine the effectiveness, cost and cost-effectiveness of group-administered behavioral treatment among community-dwelling women aged 55 to 91 years with urinary incontinence (n = 463; mean age, 64 years; 46.2% black), compared with no treatment.

Women were included if they had a score of 3 or higher on the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF), symptoms persisting for at least 3 months and no medical conditions or treatments that may affect continence. Participants were randomly assigned to either the group-administered behavioral treatment group (n = 232) or control group (n = 231). Group-administered behavioral treatment consisted of a one-time 2-hour bladder health class which was supplemented with written materials and an audio CD.

The researchers measured outcomes, including change in ICIQ-SF score, urinary incontinence severity, quality of life, perceptions of improvement, pelvic floor muscle strength and costs, at 3, 6, 9 and 12 months.

Intention-to-treat analyses showed that participants receiving group-administered behavioral treatment had consistently lower ICIQ-SF scores, compared with those in the control group; however, the projected 3-point difference was not achieved. The difference in differences was statistically significant but clinically modest (0.96 points; 95%CI, –1.51 to –0.41 points) at 3 months, according to the researchers.

The mean treatment effects were 1.36 at 6 months, 2.13 at 9 months and 1.77 at 12 months. Women in the group-administered behavioral treatment showed improved lower urinary incontinence severity, improved quality of life and better perceptions of improvement. Pelvic floor muscle strength was the only outcome that did not favor group-administered behavioral treatment. At 3 months, it cost $723 to achieve a treatment success.

“With its low cost and ease of administration, group-administered behavioral treatment is a promising first approach to enhancing access to noninvasive behavioral treatment for urinary incontinence,” Diokno and colleagues concluded. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.