J A Fantl1. 1. State University of New York and St. John's Episcopal Hospital, Smithtown, USA.
Abstract
OBJECTIVES: To review the use of behavioral modification as a treatment for urinary incontinence (UI) among individuals in the community. METHODS: The implementation of pelvic floor rehabilitation and bladder training is discussed. "Cure rates" reported in studies of community-dwelling women with UI are presented, and possible mechanisms of the treatment effect are described. RESULTS: Clinical trials of behavioral modification for UI have incorporated different therapeutic regimens and outcome measurements. On average, however, pelvic muscle rehabilitation has produced complete resolution in approximately 20% of patients and a 50% to 75% reduction in most individuals. Bladder training has produced complete resolution in fewer than 15% of patients and a 50% to 75% reduction in more than 50% of subjects. Although the mechanism of the treatment effect remains undetermined, it may involve modification of voluntary striated muscle contractility, reflex striated muscle contractility, cortical inhibition, and cortical facilitation. The structure and implementation of the technique, rather than the specific technique itself, may be responsible for the treatment effect. CONCLUSIONS: Behavioral interventions have a definite place in the management of UI. Most such therapies will reduce, rather than abolish, UI. However, the reduction in symptoms may improve the quality of life.
OBJECTIVES: To review the use of behavioral modification as a treatment for urinary incontinence (UI) among individuals in the community. METHODS: The implementation of pelvic floor rehabilitation and bladder training is discussed. "Cure rates" reported in studies of community-dwelling women with UI are presented, and possible mechanisms of the treatment effect are described. RESULTS: Clinical trials of behavioral modification for UI have incorporated different therapeutic regimens and outcome measurements. On average, however, pelvic muscle rehabilitation has produced complete resolution in approximately 20% of patients and a 50% to 75% reduction in most individuals. Bladder training has produced complete resolution in fewer than 15% of patients and a 50% to 75% reduction in more than 50% of subjects. Although the mechanism of the treatment effect remains undetermined, it may involve modification of voluntary striated muscle contractility, reflex striated muscle contractility, cortical inhibition, and cortical facilitation. The structure and implementation of the technique, rather than the specific technique itself, may be responsible for the treatment effect. CONCLUSIONS: Behavioral interventions have a definite place in the management of UI. Most such therapies will reduce, rather than abolish, UI. However, the reduction in symptoms may improve the quality of life.