Context Previous research on urge urinary incontinence has demonstrated that
multicomponent behavioral training with biofeedback is safe and effective,
yet it has not been established whether biofeedback is an essential component
that heightens therapeutic efficacy.
Objective To examine the role of biofeedback in a multicomponent behavioral training
program for urge incontinence in community-dwelling older women.
Design Prospective, randomized controlled trial conducted from April 1, 1995,
to March 30, 2001.
Setting University-based outpatient continence clinic in the United States.
Patients A volunteer sample of 222 ambulatory, nondemented, community-dwelling
women aged 55 to 92 years with urge incontinence or mixed incontinence with
urge as the predominant pattern. Patients were stratified by race, type of
incontinence (urge only vs mixed), and severity (frequency of accidents).
Interventions Patients were randomly assigned to receive 8 weeks (4 visits) of biofeedback-assisted
behavioral training (n = 73), 8 weeks (4 visits) of behavioral training without
biofeedback (verbal feedback based on vaginal palpation; n = 74), or 8 weeks
of self-administered behavioral treatment using a self-help booklet (control
condition; n = 75).
Main Outcome Measures Reduction in the number of incontinence episodes as documented in bladder
diaries, patients' perceptions and satisfaction, and changes in quality of
Results Intention-to-treat analysis showed that behavioral training with biofeedback
yielded a mean 63.1% reduction (SD, 42.7%) in incontinence, verbal feedback
a mean 69.4% reduction (SD, 32.7%), and the self-help booklet a mean 58.6%
reduction (SD, 38.8%). The 3 groups were not significantly different from
each other (P = .23). The groups differed significantly
regarding patient satisfaction: 75.0% of the biofeedback group, 85.5% of the
verbal feedback group, and 55.7% of the self-help booklet group reported being
completely satisfied with treatment (P = .001). Significant
improvements were seen across all 3 groups on 3 quality-of-life instruments,
with no significant between-group differences.
Conclusions Biofeedback to teach pelvic floor muscle control, verbal feedback based
on vaginal palpation, and a self-help booklet in a first-line behavioral training
program all achieved comparable improvements in urge incontinence in community-dwelling
older women. Patients' perceptions of treatment were significantly better
for the 2 behavioral training interventions.