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TUESDAY, July 15, 2003 (HealthDayNews) -- A new study offers new hope for those who suffer from urinary incontinence.
Several treatments are effective and none require surgery, says a report in the July 16 issue of the Journal of the American Medical Association. Even self-administered behavioral therapy can cut in half the frequency of episodes, the researchers found.
Some 13 million Americans, most of them women, suffer from urinary incontinence, which is the involuntary release of urine. There are two common forms: stress incontinence, which can be caused by something as ordinary as a cough or sneeze, and urge incontinence, which occurs without notice or stimulus. Some patients have a combination of both.
The new research should help dispel the common belief that only surgery can ease the condition, says Dr. Neil M. Resnick, a professor of medicine at the University of Pittsburgh.
Dr. Patricia A. Goode and her colleagues at the Department of Veterans Affairs Medical Center in Birmingham, Ala., tried several treatments on 200 women, aged 40 to 78, who had stress incontinence or mixed incontinence.
Some women were assigned to behavioral training, consisting of biofeedback-assisted exercises to train bladder muscles, bladder-control strategies, and self-monitoring with bladder diaries. A second group had the same behavioral training, with the addition of pelvic floor electric stimulation, which is used to activate muscles involved in bladder control. A third group was sent home and told to follow the instructions in a self-help booklet.
The frequency of incontinent episodes was the same in all groups at the start. After eight weeks, the incidence of episodes was reduced by 68.6 percent in those women given behavioral training and by 71.9 percent in those who also got electrical stimulation, a difference that is not considered statistically significance. Women who used the self-help booklet had a lower, but still marked, 52.2 percent reduction in episodes.
While electrical stimulation did not give significant improvement over behavioral training alone, "patient self-reports indicated that the women in the [electrical stimulation] group perceived significantly better outcomes," the researchers write.
"The take-home message is that nonsurgical treatments for incontinence are very effective, says Goode, an associate professor of medicine at the University of Alabama. "If you try self-help at home, you can reduce the incidence of episodes by 50 percent. If you come to a clinic for treatment, you can increase that to 70 percent."
It's impressive to see how effective the treatments are, adds Resnick, who wrote an accompanying editorial in the journal. "Their behavioral approach works in the majority of people," he says. "It doesn't cure the condition, but it does make it better."
Many family physicians overlook urinary incontinence in their patients, partly because the patients don't want to talk about it, partly because of the belief that surgery would be needed. But, Resnick says, doctors should ask their patients, especially older women, if they are having trouble.
Women should speak up, too, Goode adds. "A lot of women think this is normal after childbirth or menopause," she says. "Women need to know it is treatable and not necessarily with surgery."
"Any primary-care physician who has an interest in incontinence can learn about it," Resnick says. "If they have that interest, they can learn what they can do to treat it, or, if they can't, then to refer the patient to a physician who can."
More information
For more on urinary incontinence, visit the National Institute of Diabetes and Digestive and Kidney Diseases or Mayo Clinic.
