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Bladder Control May Be in Your Mind

Study shows behavioral therapy works as well as drugs for older women

MONDAY, July 1 (HealthDayNews)-- Despite those breezy, on-the-beach TV commercials depicting an "urgent" need for urinary incontinence drugs, a new study shows a simple form of behavior therapy may be the best line of defense for women with bladder control problems.

The research, published in the July issue of Obstetrics & Gynecology, reveals how instruction on bladder control, along with professional support, reduced urinary incontinence episodes by up to 100 percent in some women, and by 50 percent or more in the majority of the study group.

"What is really exciting about this study is that it empowers women by showing that they can take control of urinary incontinence, and that it can be done in a very simple and very inexpensive way," says study author Dr. Leslee L. Subak, an obstetrician-gynecologist at the University of California at San Francisco who specializes in treating urinary problems.

"There is basically no downside to this method of treatment -- and it should be considered the first line of defense for women suffering with incontinence, particularly age-related incontinence," Subak adds.

New York University's Dr. Victor Nitti is encouraged by the finding. However, the study, he says, is not without flaws.

"Basically, their premise is a good one -- that behavior therapy can accomplish some outstanding results -- but I'm not sure that they took into consideration that women who enter these studies are highly motivated. And I'm not sure you would find that kind of motivation in the general population," says Nitti, vice chairman of the urology department at the NYU School of Medicine.

Since motivation is key to the success of any behavior therapy program, Nitti says he's "certain we would not see these same kind of startling results in the real world."

Urinary incontinence is considered one of the most prevalent health conditions in women, affecting up to 50 percent in the post-menopausal age group. Fifteen percent of these women experience incontinence on a daily basis, often unable to control their bladder at all, day or night.

While in most instances the problem does not signify any life-threatening condition, Subak reports it has been cited as an enormous quality-of-life issue -- and one that women often find difficult to discuss, even with their doctor.

Because it's not a life-threatening health concern, such as cholesterol or high blood pressure, most primary-care doctors are not quick to ask patients about bladder control.

The combined result, she says, is that many women never discover how easy it can be to take control of their problem -- and that you don't necessarily need medication to do it.

Nitti agrees: "I think more primary-care doctors and primary-care gynecologists need to make an effort to filter out those patients who may do well with behavior therapy, and offer it to them."

Subak's study initially involved 152 women divided into two groups: 77 were randomly assigned to participate in behavioral therapy centered on urinary incontinence awareness training, while the remaining 75 women served as controls.

The women in the behavior group participated in six weekly sessions that began with basic information on urinary function, the importance of pelvic muscle strength and instructions on pelvic exercises, and details on how to keep a bladder control journal of daily voiding habits.

In subsequent support group meetings, the women discussed their diary entries and set new voiding schedules, increasing time between bathroom trips by approximately 30 minutes, as tolerated, with an end goal of three hours between voidings.

The control group received no instructions and no support, but did keep a urinary diary.

The end result: After six weeks, the women in the support group experienced a 50 percent reduction in incontinent episodes, compared with a 15 percent reduction in the control group.

After the study ended, the control group was also offered the behavior therapy, and upon their completion a second set of results were tabulated, reflecting the overall outcome of all the women.

That result: When women in both study groups were combined, doctors witnessed a 40 percent decrease in incontinent episodes, which also remained during the six month follow-up. Additionally, 30 of the women were 100 percent improved, 40 were at least 75 percent improved, and 50 were at least 50 percent improved.

Although the amount of time between bathroom visits was not reduced by any significant margin, Subak says the ability to control urges and ultimately voiding accidents was experienced by the vast majority of women in the study.

Nitti says the results were similar -- and perhaps just a bit better -- than what is expected with bladder control medications. Subak says she's delighted with the result.

"We were able to show that this simple, low-cost method of behavioral training can have a significant impact -- and it's important that women realize they can take control of this problem; they don't have to live with incontinence," Subak says.

What To Do

For a terrific fact sheet on urinary incontinence in women, visit The National Urologic and Kidney Disease Information Clearinghouse. You can also check out new data on bladder control found here.

SOURCES: Leslee L. Subak, M.D., associate professor, obstetrics and gynecology, University of California at San Francisco; Victor Nitti, M.D., associate professor, urology, and vice chairman, department of urology, New York University School of Medicine, New York City; July 2002 Obstetrics & Gynecology
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